Provider Demographics
NPI:1508215336
Name:NAIEMOLLAH, SHAHAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHAHAN
Middle Name:
Last Name:NAIEMOLLAH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 RODEO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5225
Mailing Address - Country:US
Mailing Address - Phone:323-936-0279
Mailing Address - Fax:
Practice Address - Street 1:5101 RODEO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-5225
Practice Address - Country:US
Practice Address - Phone:323-936-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist