Provider Demographics
NPI:1558708081
Name:MELAMED, FARBOD (PHARMD)
Entity Type:Individual
Prefix:
First Name:FARBOD
Middle Name:
Last Name:MELAMED
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 1:411 N PALM DR
Mailing Address - Street 2:APT 11
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4021
Mailing Address - Country:US
Mailing Address - Phone:310-422-3129
Mailing Address - Fax:
Practice Address - Street 1:465 N ROXBURY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4206
Practice Address - Country:US
Practice Address - Phone:310-273-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68252183500000X
TN37283183500000X
KY016403183500000X
NV18410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist