Healthcare Provider Details

I. General information

NPI: 1952819385
Provider Name (Legal Business Name): GOLSAR MIRABOLFATHI PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 AVENIDA FRONTERA
OCEANSIDE CA
92057-7732
US

IV. Provider business mailing address

1107 AVENIDA FRONTERA
OCEANSIDE CA
92057-7732
US

V. Phone/Fax

Practice location:
  • Phone: 832-858-8078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number76679
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76679
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number76679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: