Provider Demographics
NPI:1700074010
Name:FARNAD, PARNAZ (PHARMD)
Entity Type:Individual
Prefix:
First Name:PARNAZ
Middle Name:
Last Name:FARNAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:VENICE PHARMACY INC.
Other - Middle Name:
Other - Last Name:VENICE PHARMACY INC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1514 S VERMONT AVE STE I-2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4540
Mailing Address - Country:US
Mailing Address - Phone:213-381-6087
Mailing Address - Fax:213-381-6085
Practice Address - Street 1:1514 S VERMONT AVE STE I-2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4540
Practice Address - Country:US
Practice Address - Phone:213-381-6087
Practice Address - Fax:213-381-6085
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH53847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26-1975059OtherTAX ID NUMBER: 26-197-5059
CA26-1975059OtherTAX ID NUMBER: 26-197-5059