Healthcare Provider Details

I. General information

NPI: 1679366892
Provider Name (Legal Business Name): ALI REZA REJALI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S SAN VICENTE BLVD STE A7450
LOS ANGELES CA
90048-3311
US

IV. Provider business mailing address

127 S SAN VICENTE BLVD STE A7450
LOS ANGELES CA
90048-3311
US

V. Phone/Fax

Practice location:
  • Phone: 424-315-0528
  • Fax:
Mailing address:
  • Phone: 424-315-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number63193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: