Provider Demographics
NPI:1811279615
Name:FATIRIAN, BABAK (PHARM-D)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:FATIRIAN
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17479 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3828
Mailing Address - Country:US
Mailing Address - Phone:818-514-4020
Mailing Address - Fax:818-514-4025
Practice Address - Street 1:17479 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3828
Practice Address - Country:US
Practice Address - Phone:818-514-4020
Practice Address - Fax:818-514-4025
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist