Provider Demographics
NPI:1942697008
Name:KOSSARIAN, ABDOLREZA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ABDOLREZA
Middle Name:
Last Name:KOSSARIAN
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 1:17864 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3615
Mailing Address - Country:US
Mailing Address - Phone:818-345-5456
Mailing Address - Fax:818-345-9846
Practice Address - Street 1:17864 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3615
Practice Address - Country:US
Practice Address - Phone:818-345-5456
Practice Address - Fax:818-345-9846
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA58044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist