Provider Demographics
NPI:1952754962
Name:YERED, PAUL D (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:YERED
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 PASEO SANTA BARBARA
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6750
Mailing Address - Country:US
Mailing Address - Phone:805-444-4859
Mailing Address - Fax:805-435-1518
Practice Address - Street 1:944 PASEO SANTA BARBARA
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6750
Practice Address - Country:US
Practice Address - Phone:805-444-4859
Practice Address - Fax:805-435-1518
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43812OtherCALIFORNIA STATE BOARD OF PHARMACY