Healthcare Provider Details

I. General information

NPI: 1124573043
Provider Name (Legal Business Name): SEPIDEH NAMVAR PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26891 ALISO CREEK RD
ALISO VIEJO CA
92656-3392
US

IV. Provider business mailing address

26891 ALISO CREEK RD
ALISO VIEJO CA
92656-3392
US

V. Phone/Fax

Practice location:
  • Phone: 949-360-4081
  • Fax:
Mailing address:
  • Phone: 949-360-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: