Healthcare Provider Details

I. General information

NPI: 1285797423
Provider Name (Legal Business Name): NATHANIEL MERIDOR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7 STREET
LONG BEACH CA
90822
US

IV. Provider business mailing address

VA LONG BEACH HEALTHCARE SYSTEM 03/119 5901 EAST SEVENTH STREET
LONG BEACH CA
90822
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax:
Mailing address:
  • Phone: 562-826-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number25650
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: