Provider Demographics
NPI:1700375755
Name:MALEKHEDAYAT, PAYAM (RPH)
Entity Type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:MALEKHEDAYAT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E BOWMAN RD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-8243
Mailing Address - Country:US
Mailing Address - Phone:760-371-4979
Mailing Address - Fax:
Practice Address - Street 1:201 E BOWMAN RD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-8243
Practice Address - Country:US
Practice Address - Phone:760-371-4979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist