MEDICARE: FARDIN DADVAND

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	333600000X	Pharmacy	PHY44494	CA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326049867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARDIN DADVAND

Provider Business Mailing Address
First Line	:	1646 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5604
Country	:	US
Telephone Number	:	310-234-9991
Fax Number	:	310-234-1299

Provider Business Practice Location Address
First Line	:	1646 WESTWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5604
Country	:	US
Telephone Number	:	310-234-9991
Fax Number	:	310-234-1299

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FARDIN DADVAND
Credential	:	PHARM. D.
Telephone Number	:	310-234-9991

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	04/26/2022

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Directions to “FARDIN DADVAND ” Practice Location

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