Provider Demographics
NPI:1629676572
Name:AHADI, KAMBIZ (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:KAMBIZ
Middle Name:
Last Name:AHADI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:KAMBIZ
Other - Middle Name:
Other - Last Name:AHADIMOGHADDAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:2211 W MAGNOLIA BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1758
Mailing Address - Country:US
Mailing Address - Phone:818-238-0100
Mailing Address - Fax:818-238-0115
Practice Address - Street 1:2211 W MAGNOLIA BLVD STE 115
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1758
Practice Address - Country:US
Practice Address - Phone:818-238-0100
Practice Address - Fax:818-238-0115
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist