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General NPI Number Information
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NPI Number | 1871685446
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Entity Type | Individual
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Provider Name | OMID KHONSARI PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/23/2008
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Provider Practice Location Address
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Address Line | 824 E CARSON ST SUITE 104
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City | CARSON
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State | CA
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Zip | 90745-2262
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Country | US
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Telephone | 310-847-7624
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5977
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City | BEVERLY HILLS
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State | CA
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Zip | 90209-5977
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Country | US
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Telephone | 310-849-9587
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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 | 15432
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 60704
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License Number State | CA
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