Provider Demographics
NPI:1861892952
Name:GOUDARZI, ARAD ALLEN (PHARM D)
Entity type:Individual
Prefix:
First Name:ARAD
Middle Name:ALLEN
Last Name:GOUDARZI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NEWBURY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6436
Mailing Address - Country:US
Mailing Address - Phone:805-375-4050
Mailing Address - Fax:805-375-4120
Practice Address - Street 1:1000 NEWBURY RD STE 100
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6436
Practice Address - Country:US
Practice Address - Phone:805-375-4050
Practice Address - Fax:805-375-4120
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist