MEDICARE: DR. MARYAM JALILI PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	87359	CA
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	87359	CA

General Provider Information

NPI Number	:	1194435479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYAM JALILI PHARMD

Provider Business Mailing Address
First Line	:	14957 ARCHWOOD ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91405-4502
Country	:	US
Telephone Number	:	818-825-2783
Fax Number	:

Provider Business Practice Location Address
First Line	:	7257 W SUNSET BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-3409
Country	:	US
Telephone Number	:	323-512-0268
Fax Number	:	323-512-7953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	05/30/2026

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