Provider Demographics
NPI:1972904357
Name:PEZESHKI, PEDRAM
Entity type:Individual
Prefix:
First Name:PEDRAM
Middle Name:
Last Name:PEZESHKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 FALMOUTH AVE
Mailing Address - Street 2:412
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8692
Mailing Address - Country:US
Mailing Address - Phone:818-912-0132
Mailing Address - Fax:
Practice Address - Street 1:8601 FALMOUTH AVE
Practice Address - Street 2:412
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8692
Practice Address - Country:US
Practice Address - Phone:805-426-6817
Practice Address - Fax:805-426-6811
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist