Provider Demographics
NPI:1457040651
Name:BEHDAD, NIUSHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NIUSHA
Middle Name:
Last Name:BEHDAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 VETERAN AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5557
Mailing Address - Country:US
Mailing Address - Phone:310-754-6667
Mailing Address - Fax:
Practice Address - Street 1:2001 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6328
Practice Address - Country:US
Practice Address - Phone:310-877-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist