Healthcare Provider Details

I. General information

NPI: 1982924718
Provider Name (Legal Business Name): BENYAMIN SOLAIMAN TEHRANI PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 SAN VICENTE BLVD
LOS ANGELES CA
90049-5012
US

IV. Provider business mailing address

PO BOX 18612
ENCINO CA
91416-8612
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-1496
  • Fax:
Mailing address:
  • Phone: 818-515-6938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: