Provider Demographics
NPI:1275849879
Name:AMIRI, MOHAMAD REZA (PHARM D)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:REZA
Last Name:AMIRI
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 1:7227 SPRING CT
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1446
Mailing Address - Country:US
Mailing Address - Phone:818-348-4366
Mailing Address - Fax:
Practice Address - Street 1:21949 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1725
Practice Address - Country:US
Practice Address - Phone:818-348-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 51496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist