Provider Demographics
NPI:1265565717
Name:JAVAN, BAHMAN A (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BAHMAN
Middle Name:A
Last Name:JAVAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:BOB
Other - Middle Name:A
Other - Last Name:JAVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1101 OFFICE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5937
Mailing Address - Country:US
Mailing Address - Phone:850-805-2080
Mailing Address - Fax:
Practice Address - Street 1:1101 OFFICE WOODS DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5937
Practice Address - Country:US
Practice Address - Phone:850-805-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018940183500000X
FLPU91721835P0018X
FLPS42202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPU9172OtherCONSULTANT PHARMACIST