Provider Demographics
NPI:1841561206
Name:DOROUDGAR, SHADI (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:DOROUDGAR
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 1:1146 E LEXINGTON DR UNIT 304
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-5076
Mailing Address - Country:US
Mailing Address - Phone:818-281-5856
Mailing Address - Fax:
Practice Address - Street 1:10811 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7368
Practice Address - Country:US
Practice Address - Phone:818-281-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist