MEDICARE: MONA ZOHREHVAND 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	63202	CA

General Provider Information

NPI Number	:	1992011605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA ZOHREHVAND PHARM. D.

Provider Business Mailing Address
First Line	:	5029 DUNSMORE AVE
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-1108
Country	:	US
Telephone Number	:	310-403-6944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 WILSHIRE BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5610
Country	:	US
Telephone Number	:	310-829-3951
Fax Number	:

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

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	08/19/2010

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