Provider Demographics
NPI:1497184113
Name:GHAVAMI, RAMTIN
Entity Type:Individual
Prefix:
First Name:RAMTIN
Middle Name:
Last Name:GHAVAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 RESEDA BLVD A-1
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4219
Mailing Address - Country:US
Mailing Address - Phone:877-209-9111
Mailing Address - Fax:877-209-9150
Practice Address - Street 1:2243 EAGLE GLEN PKWY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-0785
Practice Address - Country:US
Practice Address - Phone:951-279-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH67639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist