Provider Demographics
NPI:1740592740
Name:MAHMOUDI, VAHID (PHARM D)
Entity Type:Individual
Prefix:
First Name:VAHID
Middle Name:
Last Name:MAHMOUDI
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 1:12165 LICIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3768
Mailing Address - Country:US
Mailing Address - Phone:858-538-0859
Mailing Address - Fax:
Practice Address - Street 1:10631 TIERRASANTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2605
Practice Address - Country:US
Practice Address - Phone:858-576-0972
Practice Address - Fax:858-576-0035
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist