Provider Demographics
NPI:1962192989
Name:KASHANI, MELICA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MELICA
Middle Name:
Last Name:KASHANI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:MELICA
Other - Middle Name:
Other - Last Name:BAGHERIKASHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15674 BERNARDO CENTER DR APT 1605
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1822
Mailing Address - Country:US
Mailing Address - Phone:858-442-3837
Mailing Address - Fax:
Practice Address - Street 1:15674 BERNARDO CENTER DR APT 1605
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1822
Practice Address - Country:US
Practice Address - Phone:858-442-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist