Provider Demographics
NPI:1619634557
Name:ETEMADFARD, YASAMAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:YASAMAN
Middle Name:
Last Name:ETEMADFARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4459 ESTRELLA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4651
Mailing Address - Country:US
Mailing Address - Phone:405-657-4165
Mailing Address - Fax:
Practice Address - Street 1:4459 ESTRELLA AVE APT 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4651
Practice Address - Country:US
Practice Address - Phone:405-657-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy