Provider Demographics
NPI:1760952717
Name:MOGHADAM, ASHKAN GHOULIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ASHKAN
Middle Name:GHOULIAN
Last Name:MOGHADAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ASHKAN
Other - Middle Name:
Other - Last Name:MOGHADAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1025 E ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-5522
Mailing Address - Country:US
Mailing Address - Phone:213-742-6849
Mailing Address - Fax:
Practice Address - Street 1:1025 E ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:213-742-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist