Provider Demographics
NPI:1659754950
Name:BADIEE, BANAFSHEH (RPH)
Entity Type:Individual
Prefix:
First Name:BANAFSHEH
Middle Name:
Last Name:BADIEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHAY
Other - Middle Name:
Other - Last Name:BADIEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10672 PASSERINE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4200
Mailing Address - Country:US
Mailing Address - Phone:619-708-9915
Mailing Address - Fax:
Practice Address - Street 1:10672 PASSERINE WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4200
Practice Address - Country:US
Practice Address - Phone:619-708-9915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-04
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist