MEDICARE: YASAMAN ETEMADFARD 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1619634557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASAMAN ETEMADFARD PHARMD

Provider Business Mailing Address
First Line	:	4459 ESTRELLA AVE APT 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4651
Country	:	US
Telephone Number	:	405-657-4165
Fax Number	:

Provider Business Practice Location Address
First Line	:	4459 ESTRELLA AVE APT 2
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4651
Country	:	US
Telephone Number	:	405-657-4165
Fax Number	:

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

Provider Enumeration Date	:	11/28/2021
Last Update Date	:	11/28/2021

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Directions to “ YASAMAN ETEMADFARD PHARMD” Practice Location

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