Provider Demographics
NPI:1033287412
Name:SAMOUHA, BAHRAM (PHARM D)
Entity Type:Individual
Prefix:
First Name:BAHRAM
Middle Name:
Last Name:SAMOUHA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N PALM DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-273-2181
Mailing Address - Fax:310-657-7979
Practice Address - Street 1:8722 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035
Practice Address - Country:US
Practice Address - Phone:310-657-6999
Practice Address - Fax:310-657-7979
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist