Healthcare Provider Details

I. General information

NPI: 1033656830
Provider Name (Legal Business Name): HEDYEH OMRANIPOUR PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 COAST VILLAGE RD
MONTECITO CA
93108-2715
US

IV. Provider business mailing address

1040 COAST VILLAGE RD
MONTECITO CA
93108-2715
US

V. Phone/Fax

Practice location:
  • Phone: 818-231-9176
  • Fax:
Mailing address:
  • Phone: 818-231-9176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: