Healthcare Provider Details

I. General information

NPI: 1972058600
Provider Name (Legal Business Name): MARINE ZATIKIAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 W MAGNOLIA BLVD
BURBANK CA
91506-1830
US

IV. Provider business mailing address

2528 N VERMONT AVE
LOS ANGELES CA
90027-1243
US

V. Phone/Fax

Practice location:
  • Phone: 818-260-0010
  • Fax: 888-641-7979
Mailing address:
  • Phone: 310-713-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: