Provider Demographics
NPI:1366987828
Name:KHOOBYARI, SHAHRZAD
Entity type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:KHOOBYARI
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 1:2520 WEBB CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1541
Mailing Address - Country:US
Mailing Address - Phone:949-278-8899
Mailing Address - Fax:
Practice Address - Street 1:2520 WEBB CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1541
Practice Address - Country:US
Practice Address - Phone:949-278-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist