Provider Demographics
NPI:1730452673
Name:BIDOKHTINEZHAD, FERESHTEH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FERESHTEH
Middle Name:
Last Name:BIDOKHTINEZHAD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4557 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5185
Mailing Address - Country:US
Mailing Address - Phone:805-388-0800
Mailing Address - Fax:805-388-1515
Practice Address - Street 1:4557 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5185
Practice Address - Country:US
Practice Address - Phone:805-388-0800
Practice Address - Fax:805-388-1515
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537671835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063681195OtherMEDICAL