Provider Demographics
NPI:1154632909
Name:NOVIN-BAHERAN, ALI A (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALI
Middle Name:A
Last Name:NOVIN-BAHERAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2300
Mailing Address - Country:US
Mailing Address - Phone:805-529-5726
Mailing Address - Fax:805-529-8533
Practice Address - Street 1:3941 SPRING RD
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2300
Practice Address - Country:US
Practice Address - Phone:805-529-5726
Practice Address - Fax:805-529-8533
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist