Provider Demographics
NPI:1285902213
Name:JAFARI, MARY H
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:JAFARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 S BEVERLY GLEN BLVD APT 402
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5148
Mailing Address - Country:US
Mailing Address - Phone:310-869-3586
Mailing Address - Fax:
Practice Address - Street 1:2015 S BEVERLY GLEN BLVD APT 402
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5148
Practice Address - Country:US
Practice Address - Phone:310-869-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist