MEDICARE: SHANNON BAHARI MOGHADAM PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	86887	CA

General Provider Information

NPI Number	:	1003524703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BAHARI MOGHADAM PHARMD

Provider Business Mailing Address
First Line	:	10660 WILSHIRE BLVD APT 310
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4523
Country	:	US
Telephone Number	:	424-230-2122
Fax Number	:

Provider Business Practice Location Address
First Line	:	9045 WILSHIRE BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1829
Country	:	US
Telephone Number	:	310-273-5252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2022
Last Update Date	:	11/10/2022

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