Healthcare Provider Details

I. General information

NPI: 1194063289
Provider Name (Legal Business Name): SHERRY KHADAVI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHERRY BRAL PHARM.D

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 DONA MARIA DR
STUDIO CITY CA
91604-4263
US

IV. Provider business mailing address

3311 DONA MARIA DR
STUDIO CITY CA
91604-4263
US

V. Phone/Fax

Practice location:
  • Phone: 310-924-8366
  • Fax:
Mailing address:
  • Phone: 310-924-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: