Provider Demographics
NPI:1356657886
Name:SIASSI, DARA (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:SIASSI
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 PELHAM AVE
Mailing Address - Street 2:APT. 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4527
Mailing Address - Country:US
Mailing Address - Phone:818-653-2120
Mailing Address - Fax:
Practice Address - Street 1:23335 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-3027
Practice Address - Country:US
Practice Address - Phone:661-259-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist