Healthcare Provider Details

I. General information

NPI: 1629423348
Provider Name (Legal Business Name): SOHAIL KHODABAKHSHI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 WESTWOOD PLAZA
LOS ANGELES CA
90095
US

IV. Provider business mailing address

10905 OHIO AVENUE APT 312
LOS ANGELES CA
90024
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-8500
  • Fax:
Mailing address:
  • Phone: 901-335-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: