Provider Demographics
NPI:1487139432
Name:KANDILIAN, FAGHARCH (RPH)
Entity type:Individual
Prefix:
First Name:FAGHARCH
Middle Name:
Last Name:KANDILIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:FAGHARCH
Other - Middle Name:
Other - Last Name:KANDILIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3883 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:626-351-0589
Mailing Address - Fax:
Practice Address - Street 1:3883 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107
Practice Address - Country:US
Practice Address - Phone:626-351-0589
Practice Address - Fax:626-351-1612
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist