Healthcare Provider Details

I. General information

NPI: 1417260233
Provider Name (Legal Business Name): BAHAREH JAVADI PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GLENDON AVE
LOS ANGELES CA
90024-2907
US

IV. Provider business mailing address

1001 GLENDON AVE
LOS ANGELES CA
90024-2907
US

V. Phone/Fax

Practice location:
  • Phone: 310-209-0708
  • Fax: 310-209-0348
Mailing address:
  • Phone: 310-209-0708
  • Fax: 310-209-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: