Provider Demographics
NPI:1518347400
Name:JAHEDSHOAR, BABAK (PHARMD)
Entity Type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:JAHEDSHOAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 N GREEN VALLEY PKWY
Mailing Address - Street 2:APT 3422
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5833
Mailing Address - Country:US
Mailing Address - Phone:702-635-4433
Mailing Address - Fax:
Practice Address - Street 1:1770 N GREEN VALLEY PKWY
Practice Address - Street 2:APT 3422
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5833
Practice Address - Country:US
Practice Address - Phone:702-635-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18818183500000X
CA72507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist