Provider Demographics
NPI:1962138271
Name:YOUSEFIAN, SHOLEH (PHARMD)
Entity type:Individual
Prefix:
First Name:SHOLEH
Middle Name:
Last Name:YOUSEFIAN
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 1:1921 N REDDING WAY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1617
Mailing Address - Country:US
Mailing Address - Phone:626-622-7002
Mailing Address - Fax:909-593-0797
Practice Address - Street 1:555 N BENSON AVE STE FP
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5075
Practice Address - Country:US
Practice Address - Phone:909-593-2787
Practice Address - Fax:909-593-0797
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH49770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist