MEDICARE: DR. TANAZ DIBAGOHAR PHARM. D.

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	RPH52440	CA

General Provider Information

NPI Number	:	1235424714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANAZ DIBAGOHAR PHARM. D.

Provider Business Mailing Address
First Line	:	18266 SUGARMAN ST
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-4324
Country	:	US
Telephone Number	:	818-344-5752
Fax Number	:

Provider Business Practice Location Address
First Line	:	10349 SEPULVEDA BLVD
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-2421
Country	:	US
Telephone Number	:	818-891-1941
Fax Number	:

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

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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