Provider Demographics
NPI:1992053045
Name:FATURECHI DAVIDOFF, BAHAR (PHARMD)
Entity type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:FATURECHI DAVIDOFF
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 1:10660 WILSHIRE BLVD APT 904
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-7303
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:818-671-5682
Practice Address - Street 1:8510 BALBOA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5810
Practice Address - Country:US
Practice Address - Phone:310-475-2137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist