Provider Demographics
NPI:1790146173
Name:SABOURI, BIJAN JAMIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BIJAN
Middle Name:JAMIE
Last Name:SABOURI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3606
Mailing Address - Country:US
Mailing Address - Phone:619-442-0303
Mailing Address - Fax:619-442-0305
Practice Address - Street 1:455 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3606
Practice Address - Country:US
Practice Address - Phone:619-442-0303
Practice Address - Fax:619-442-0305
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist