Provider Demographics
NPI:1841587524
Name:KATIV, AMIR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:KATIV
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 1:1893 W MALVERN AVE
Mailing Address - Street 2:TARGET PHARMACY STORE NUMBER T-1383
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2403
Mailing Address - Country:US
Mailing Address - Phone:714-278-9022
Mailing Address - Fax:714-278-9022
Practice Address - Street 1:1893 W MALVERN AVE
Practice Address - Street 2:TARGET PHARMACY STORE NUMBER T-1383
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2403
Practice Address - Country:US
Practice Address - Phone:714-278-9022
Practice Address - Fax:714-278-9022
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY45555Medicaid