Provider Demographics
NPI:1497933790
Name:BAHADOURIAN, DIRAN B (RPH)
Entity Type:Individual
Prefix:MR
First Name:DIRAN
Middle Name:B
Last Name:BAHADOURIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 E WASHINGTON BLVD
Mailing Address - Street 2:105
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1666
Mailing Address - Country:US
Mailing Address - Phone:626-398-1696
Mailing Address - Fax:626-398-9860
Practice Address - Street 1:1864 E WASHINGTON BLVD
Practice Address - Street 2:105
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1666
Practice Address - Country:US
Practice Address - Phone:626-398-1696
Practice Address - Fax:626-398-9860
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH35870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA343070Medicaid
CAPHA343070Medicaid
CA0619160001Medicare NSC