Provider Demographics
NPI:1316502404
Name:EFTEKHARI, ELHAM SADAT (PHARMD)
Entity type:Individual
Prefix:
First Name:ELHAM
Middle Name:SADAT
Last Name:EFTEKHARI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1738
Mailing Address - Country:US
Mailing Address - Phone:909-608-7833
Mailing Address - Fax:
Practice Address - Street 1:2121 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1738
Practice Address - Country:US
Practice Address - Phone:909-608-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist