Provider Demographics
NPI:1396389318
Name:FARD, LAILA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAILA
Middle Name:
Last Name:FARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14049 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3511
Mailing Address - Country:US
Mailing Address - Phone:747-233-6108
Mailing Address - Fax:
Practice Address - Street 1:14049 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3511
Practice Address - Country:US
Practice Address - Phone:747-233-6108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-12-27
Deactivation Date:2019-12-19
Deactivation Code:
Reactivation Date:2019-12-27
Provider Licenses
StateLicense IDTaxonomies
174H00000X
CA81190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174H00000XOther Service ProvidersHealth Educator