Healthcare Provider Details

I. General information

NPI: 1679830426
Provider Name (Legal Business Name): GHAZAL VESSAL PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROBERTSON BLVD SUITE 601
BEVERLY HILLS CA
90211-1788
US

IV. Provider business mailing address

PO BOX 54679
LOS ANGELES CA
90054-0679
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3534
  • Fax: 310-385-2949
Mailing address:
  • Phone: 310-967-1884
  • Fax: 310-967-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: