Provider Demographics
NPI:1972823441
Name:POURAHMAD, KIM SOHEILA (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:SOHEILA
Last Name:POURAHMAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10465 SUNLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040
Mailing Address - Country:US
Mailing Address - Phone:818-352-4129
Mailing Address - Fax:818-951-4397
Practice Address - Street 1:10465 SUNLAND BLVD
Practice Address - Street 2:RITE-AID PHARMACY
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040
Practice Address - Country:US
Practice Address - Phone:818-352-4129
Practice Address - Fax:818-951-4397
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist