Provider Demographics
NPI:1386145324
Name:NAZIRI, FARHAD FRED (RPH)
Entity type:Individual
Prefix:
First Name:FARHAD
Middle Name:FRED
Last Name:NAZIRI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:UNIT 102
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4146
Mailing Address - Country:US
Mailing Address - Phone:818-885-7722
Mailing Address - Fax:
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:102
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4146
Practice Address - Country:US
Practice Address - Phone:818-885-7722
Practice Address - Fax:818-349-6576
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist