Provider Demographics
NPI:1972007979
Name:LAVAEE, NAZANIN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NAZANIN
Middle Name:
Last Name:LAVAEE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 FALLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3543
Mailing Address - Country:US
Mailing Address - Phone:818-719-8610
Mailing Address - Fax:818-719-8612
Practice Address - Street 1:6433 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3543
Practice Address - Country:US
Practice Address - Phone:818-719-8610
Practice Address - Fax:818-719-8612
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA71297OtherCALIFORNIA BOARD OF PHARMACY