Provider Demographics
NPI:1023489473
Name:PARVEZ, KHONDKER MASUM (PHARMD)
Entity type:Individual
Prefix:
First Name:KHONDKER
Middle Name:MASUM
Last Name:PARVEZ
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 1:7939 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3714
Mailing Address - Country:US
Mailing Address - Phone:909-565-3750
Mailing Address - Fax:
Practice Address - Street 1:2050 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6228
Practice Address - Country:US
Practice Address - Phone:909-792-6260
Practice Address - Fax:909-798-6672
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA65848OtherPHARMACIST LICENSE