Healthcare Provider Details

I. General information

NPI: 1811368285
Provider Name (Legal Business Name): ANI EKIZIAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 BALBOA BLVD STE 100
GRANADA HILLS CA
91344
US

IV. Provider business mailing address

10605 BALBOA BLVD STE 100
GRANADA HILLS CA
91344-6367
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number73480
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number73480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: