Provider Demographics
NPI:1881963387
Name:FARAHMAND, KHODAYAR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KHODAYAR
Middle Name:
Last Name:FARAHMAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14020 MONTFORT CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4282
Mailing Address - Country:US
Mailing Address - Phone:858-395-9922
Mailing Address - Fax:
Practice Address - Street 1:8766 NAVAJO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2722
Practice Address - Country:US
Practice Address - Phone:619-667-8764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist