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
- Last updated
- Jul 21, 2022
- 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
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 |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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": [],
"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.