MEDICARE: SALLY ASGHARZADEH

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	85486	CA

General Provider Information

NPI Number	:	1811727209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY ASGHARZADEH

Provider Business Mailing Address
First Line	:	1845 BUTLER AVE APT 312
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5496
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 UCLA MEDICAL PLZ STE 150
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-7001
Country	:	US
Telephone Number	:	310-208-2340
Fax Number	:

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

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	08/01/2024

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Directions to “ SALLY ASGHARZADEH ” Practice Location

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