Provider Demographics
NPI:1518235449
Name:GHORBANI, PAYAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:GHORBANI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:GHORBANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1028 S SAN FERNANDO BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1537
Mailing Address - Country:US
Mailing Address - Phone:818-324-6480
Mailing Address - Fax:
Practice Address - Street 1:1028 S SAN FERNANDO BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1537
Practice Address - Country:US
Practice Address - Phone:818-324-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist