Provider Demographics
NPI:1013408186
Name:ARJOMAND, MAHIYAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAHIYAR
Middle Name:
Last Name:ARJOMAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4558 ADMIRALTY WAY
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5417
Mailing Address - Country:US
Mailing Address - Phone:310-823-5311
Mailing Address - Fax:310-577-7562
Practice Address - Street 1:4558 ADMIRALTY WAY
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5417
Practice Address - Country:US
Practice Address - Phone:310-823-5311
Practice Address - Fax:310-577-7562
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020103491835P0018X, 1835P1200X, 1835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care