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NPI Code Detail

MEDICARE: BEHNAM AMIR-BEHBOUDI PHARMACIST

MEDICARE: BEHNAM AMIR-BEHBOUDI PHARMACIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist46732CA

General Provider Information

NPI Number : 1104348408
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEHNAM AMIR-BEHBOUDI PHARMACIST
Provider Business Mailing Address
First Line : 22775 CHARLEMONT PL
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-4915
Country : US
Telephone Number : 818-445-2221
Fax Number :
Provider Business Practice Location Address
First Line : 2505 SANTA MONICA BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2011
Country : US
Telephone Number : 310-828-6456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2017
Last Update Date : 07/10/2017

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