Provider Demographics
NPI:1962798447
Name:RAHNAVARDAN, ANGELIN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ANGELIN
Middle Name:
Last Name:RAHNAVARDAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14920 RAYMER ST
Mailing Address - Street 2:T1309
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1146
Mailing Address - Country:US
Mailing Address - Phone:818-922-1002
Mailing Address - Fax:818-922-1002
Practice Address - Street 1:14920 RAYMER ST
Practice Address - Street 2:T1309
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1146
Practice Address - Country:US
Practice Address - Phone:818-922-1002
Practice Address - Fax:818-922-1002
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist