Provider Demographics
NPI:1689225039
Name:NASSI, PEDRAM (PHARM D)
Entity Type:Individual
Prefix:
First Name:PEDRAM
Middle Name:
Last Name:NASSI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16931 BUSHARD ST # AT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2819
Mailing Address - Country:US
Mailing Address - Phone:310-889-4666
Mailing Address - Fax:
Practice Address - Street 1:16931 BUSHARD ST # AT
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2819
Practice Address - Country:US
Practice Address - Phone:310-889-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist