Healthcare Provider Details

I. General information

NPI: 1417230202
Provider Name (Legal Business Name): KEIVAN RAHAVARD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 VENTURA BLVD
STUDIO CITY CA
91604-3546
US

IV. Provider business mailing address

11000 VENTURA BLVD
STUDIO CITY CA
91604-3546
US

V. Phone/Fax

Practice location:
  • Phone: 818-761-6563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH62988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: