Provider Demographics
NPI:1134694458
Name:ALIBANAEI, ALIREZA (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:ALIBANAEI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-0701
Mailing Address - Country:US
Mailing Address - Phone:818-634-4198
Mailing Address - Fax:818-436-0518
Practice Address - Street 1:552 SESPE AVE
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1957
Practice Address - Country:US
Practice Address - Phone:805-242-4575
Practice Address - Fax:818-436-0518
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist