Provider Demographics
NPI:1629474101
Name:SHAVALIAN, BEHNAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BEHNAM
Middle Name:
Last Name:SHAVALIAN
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 1:1014 E. AVENIDA DE LOS ARBOLES
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4709
Mailing Address - Country:US
Mailing Address - Phone:805-241-0935
Mailing Address - Fax:805-241-0936
Practice Address - Street 1:1014 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4709
Practice Address - Country:US
Practice Address - Phone:805-241-0935
Practice Address - Fax:805-241-0936
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist