Provider Demographics
NPI:1972972610
Name:TAHERI, LALEH (PHARMD)
Entity type:Individual
Prefix:
First Name:LALEH
Middle Name:
Last Name:TAHERI
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 1:2865 E COAST HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2256
Mailing Address - Country:US
Mailing Address - Phone:949-644-7575
Mailing Address - Fax:949-644-2340
Practice Address - Street 1:2865 E COAST HWY STE 150
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2256
Practice Address - Country:US
Practice Address - Phone:949-644-7575
Practice Address - Fax:949-644-2340
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 64858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY64858OtherBOARD OF PHARMACY