Provider Demographics
NPI:1174831028
Name:KOHAN, AMIR SHAWN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:SHAWN
Last Name:KOHAN
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 1:16060 VENTURA BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4427
Mailing Address - Country:US
Mailing Address - Phone:818-387-8119
Mailing Address - Fax:
Practice Address - Street 1:16060 VENTURA BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4427
Practice Address - Country:US
Practice Address - Phone:818-387-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 64521183500000X
CA510523336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336S0011XSuppliersPharmacySpecialty Pharmacy