Active NPI
Gholam Reza Rouzitalab, PHARM.D
- Pharmacist
- Poway, CA
National Provider Identifier
1154570463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 46548
- Practice address
- 14837 Pomerado Rd
Poway, CA 92064-2803 - Phone
- (714) 900-0672
- Fax
- (858) 842-4257
- NPI assigned
- Sep 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11626 | NV | |
| Pharmacist | 183500000X | 46548 | CA | Primary |
Addresses
Primary practice location
14837 Pomerado Rd
Poway, CA 92064-2803
Mailing address
1382 S Hale Ave.
Escondido, CA 92029-3048
Phone (714) 900-0672
Other practice location 1
1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-5527 ext. 3126
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831613793 | Other | CA | NPPES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46548 | CA | MD | Pharmacist |
| 11626 | NV | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1154570463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1382 S HALE AVE.",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920293048",
"telephone_number": "714-900-0672",
"fax_number": "858-842-4257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14837 POMERADO RD",
"city": "POWAY",
"state": "CA",
"postal_code": "920642803",
"telephone_number": "714-900-0672",
"fax_number": "858-842-4257"
}
],
"practiceLocations": [
{
"address_1": "1200 Grant Blvd W",
"address_purpose": "LOCATION",
"city": "Wabasha",
"state": "MN",
"postal_code": "559811042",
"country_code": "US",
"telephone_number": "651-565-5527 x3126",
"fax_number": "651-565-5677",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROUZITALAB",
"first_name": "GHOLAM",
"middle_name": "REZA",
"credential": "PHARM.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-10",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "11626",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "46548",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPPES",
"identifier": "1831613793",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poway, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.