Provider Demographics
NPI:1093430563
Name:SIMONIAN, BRADLEY C (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:C
Last Name:SIMONIAN
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 1:2141 S HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4243
Mailing Address - Country:US
Mailing Address - Phone:626-330-8775
Mailing Address - Fax:
Practice Address - Street 1:2141 S HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4243
Practice Address - Country:US
Practice Address - Phone:626-825-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist