Provider Demographics
NPI:1730450073
Name:AGHABABASHIRAZI, SHAHIN (RPH)
Entity type:Individual
Prefix:
First Name:SHAHIN
Middle Name:
Last Name:AGHABABASHIRAZI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2701
Mailing Address - Country:US
Mailing Address - Phone:310-435-9837
Mailing Address - Fax:310-659-4665
Practice Address - Street 1:500 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2302
Practice Address - Country:US
Practice Address - Phone:213-623-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist