MEDICARE: LALEH TAHERI 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	RPH 64858	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY64858	OTHER	CA	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1972972610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LALEH TAHERI PHARM.D.

Provider Business Mailing Address
First Line	:	2865 E COAST HWY STE 150
Second Line	:
City	:	CORONA DEL MAR
State	:	CA
Zip	:	92625-2256
Country	:	US
Telephone Number	:	949-644-7575
Fax Number	:	949-644-2340

Provider Business Practice Location Address
First Line	:	2865 E COAST HWY STE 150
Second Line	:
City	:	CORONA DEL MAR
State	:	CA
Zip	:	92625-2256
Country	:	US
Telephone Number	:	949-644-7575
Fax Number	:	949-644-2340

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

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	07/21/2016

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Directions to “ LALEH TAHERI PHARM.D.” Practice Location

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