Provider Demographics
NPI:1881279263
Name:FARVARDIN, SHOLEH
Entity type:Individual
Prefix:
First Name:SHOLEH
Middle Name:
Last Name:FARVARDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 CARSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2358
Mailing Address - Country:US
Mailing Address - Phone:562-425-8045
Mailing Address - Fax:562-421-0738
Practice Address - Street 1:7250 CARSON BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2358
Practice Address - Country:US
Practice Address - Phone:562-425-8045
Practice Address - Fax:562-421-0738
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist