Provider Demographics
NPI:1356087951
Name:ARDEBILI, BRIAN JONATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JONATHAN
Last Name:ARDEBILI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23693 CALABASAS RD STE B
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3467
Mailing Address - Country:US
Mailing Address - Phone:818-403-3072
Mailing Address - Fax:818-356-8804
Practice Address - Street 1:16461 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4368
Practice Address - Country:US
Practice Address - Phone:818-986-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist