Healthcare Provider Details

I. General information

NPI: 1154908572
Provider Name (Legal Business Name): MOJDEH ROUHANI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19950 RINALDI ST STE 102
PORTER RANCH CA
91326-4141
US

IV. Provider business mailing address

19950 RINALDI ST STE 102
PORTER RANCH CA
91326-4141
US

V. Phone/Fax

Practice location:
  • Phone: 818-360-1915
  • Fax: 818-368-4987
Mailing address:
  • Phone: 818-360-1915
  • Fax: 818-367-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number48684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: