=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982975280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NILOUFAR PARYA HOSSEINI PHARMACIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2012
-----------------------------------------------------
Last Update Date | 01/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12204 PALMER DRIVE
-----------------------------------------------------
City | MOORPARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-529-6936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12204 PALMER DR
-----------------------------------------------------
City | MOORPARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93021-8779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-529-6936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | RPH55307
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------