Provider Demographics
NPI:1538328208
Name:OFOGH, BABAK (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:OFOGH
Suffix:
Gender:M
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 1:1526 PALOS VERDES MALL
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2229
Mailing Address - Country:US
Mailing Address - Phone:925-939-8378
Mailing Address - Fax:925-939-9837
Practice Address - Street 1:1526 PALOS VERDES MALL
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2229
Practice Address - Country:US
Practice Address - Phone:925-939-8378
Practice Address - Fax:925-939-9837
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist