Provider Demographics
NPI:1033546858
Name:BOOSTANFAR, MICHELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:BOOSTANFAR
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:BOOSTANFAR
Other - Last Name:KALAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:10450 WILSHIRE BLVD UNIT 6H
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10450 WILSHIRE BLVD UNIT 6H
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4610
Practice Address - Country:US
Practice Address - Phone:818-235-6735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist