Provider Demographics
NPI:1457565517
Name:YAZDANY, CYRUS (PHARMD PHD)
Entity Type:Individual
Prefix:
First Name:CYRUS
Middle Name:
Last Name:YAZDANY
Suffix:
Gender:M
Credentials:PHARMD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 ARTESIA BLVD
Mailing Address - Street 2:#11A
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3166
Mailing Address - Country:US
Mailing Address - Phone:310-371-8866
Mailing Address - Fax:310-371-5077
Practice Address - Street 1:2301 ARTESIA BLVD
Practice Address - Street 2:#11A
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3166
Practice Address - Country:US
Practice Address - Phone:310-371-8866
Practice Address - Fax:310-371-5077
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 41781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 357300Medicaid