MEDICARE: DR. KEIVAN RAHAVARD PHARM.D.

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	RPH62988	CA

General Provider Information

NPI Number	:	1417230202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEIVAN RAHAVARD PHARM.D.

Provider Business Mailing Address
First Line	:	11000 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3546
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11000 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3546
Country	:	US
Telephone Number	:	818-761-6563
Fax Number	:

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

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	11/05/2014

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