Provider Demographics
NPI:1982316493
Name:SHAHBAZIAN, MASIS (PHARM D)
Entity Type:Individual
Prefix:
First Name:MASIS
Middle Name:
Last Name:SHAHBAZIAN
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 1:1652 LARCO WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1341
Mailing Address - Country:US
Mailing Address - Phone:818-480-0654
Mailing Address - Fax:
Practice Address - Street 1:1652 LARCO WAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-1341
Practice Address - Country:US
Practice Address - Phone:818-480-0654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH59129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist