Healthcare Provider Details

I. General information

NPI: 1811381635
Provider Name (Legal Business Name): SHAHRZAD SARAIE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12842 VENTURA BLVD
STUDIO CITY CA
91604-2369
US

IV. Provider business mailing address

1 WELWYN RD # 273
GREAT NECK NY
11021-3527
US

V. Phone/Fax

Practice location:
  • Phone: 818-818-8181
  • Fax:
Mailing address:
  • Phone: 818-000-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: