Provider Demographics
NPI:1124015003
Name:BUBAR, EDWARD A (PHARM D)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:BUBAR
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 1:1245 WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1171
Mailing Address - Country:US
Mailing Address - Phone:310-571-2501
Mailing Address - Fax:
Practice Address - Street 1:8500 MELROSE AVE
Practice Address - Street 2:#109
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-5145
Practice Address - Country:US
Practice Address - Phone:310-358-2400
Practice Address - Fax:310-358-2410
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA 31000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist