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General NPI Number Information
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NPI Number | 1861893901
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Entity Type | Individual
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Provider Name | KOUSHYAR POUROMID
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Gender | Male
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 18735 VENTURA BLVD
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City | TARZANA
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State | CA
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Zip | 91356-3302
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Country | US
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Telephone | 818-743-0011
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Fax | 818-743-0022
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Provider Business Mailing Address
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Address Line | 23620 DRACO WAY
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City | WEST HILLS
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State | CA
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Zip | 91307-1352
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Country | US
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Telephone | 818-917-8851
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 70951
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License Number State | CA
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