Healthcare Provider Details

I. General information

NPI: 1376095570
Provider Name (Legal Business Name): NEELOUFAR FAKOURFAR PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 JERONIMO RD
IRVINE CA
92618-1908
US

IV. Provider business mailing address

9401 JERONIMO RD # 275
IRVINE CA
92618-1908
US

V. Phone/Fax

Practice location:
  • Phone: 714-516-5540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: