Healthcare Provider Details

I. General information

NPI: 1629559810
Provider Name (Legal Business Name): DADGAR YEGANEH PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK BLVD # 104
TARZANA CA
91356-2804
US

IV. Provider business mailing address

18370 BURBANK BLVD # 104
TARZANA CA
91356-2804
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-3600
  • Fax:
Mailing address:
  • Phone: 818-996-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17970
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65295
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: