MEDICARE: AFREH KHAZAEE PHARMD

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
1	183500000X	Pharmacist	44814	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH44814	OTHER	CA	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1710493549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFREH KHAZAEE PHARMD

Provider Business Mailing Address
First Line	:	7360 SANTA MONICA BLVD # 101
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6619
Country	:	US
Telephone Number	:	310-360-9969
Fax Number	:	310-360-9959

Provider Business Practice Location Address
First Line	:	7360 SANTA MONICA BLVD # 101
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6619
Country	:	US
Telephone Number	:	310-360-9969
Fax Number	:	310-360-9959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	12/15/2017

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