=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467676874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BABIK RUBEN KOHANTEB PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5156 OTIS AVE
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-618-1200
-----------------------------------------------------
Fax | 818-905-0016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5156 OTIS AVE
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-618-1200
-----------------------------------------------------
Fax | 818-905-0016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 47836
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------