Provider Demographics
NPI:1710493549
Name:KHAZAEE, AFREH (PHARMD)
Entity Type:Individual
Prefix:
First Name:AFREH
Middle Name:
Last Name:KHAZAEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 SANTA MONICA BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6619
Mailing Address - Country:US
Mailing Address - Phone:310-360-9969
Mailing Address - Fax:310-360-9959
Practice Address - Street 1:7360 SANTA MONICA BLVD # 101
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6619
Practice Address - Country:US
Practice Address - Phone:310-360-9969
Practice Address - Fax:310-360-9959
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH44814OtherBOARD OF PHARMACY