Provider Demographics
NPI:1649804212
Name:KAVOOSI, RYAN N/A (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:N/A
Last Name:KAVOOSI
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 1:6236 LINDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-7117
Mailing Address - Country:US
Mailing Address - Phone:818-857-6757
Mailing Address - Fax:
Practice Address - Street 1:18441 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4201
Practice Address - Country:US
Practice Address - Phone:818-996-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist