Healthcare Provider Details

I. General information

NPI: 1861772659
Provider Name (Legal Business Name): ANNE NICOLE DEUKMEDJIAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N ROSE AVE
OXNARD CA
93036-2681
US

IV. Provider business mailing address

512 N VENTU PARK RD
THOUSAND OAKS CA
91320-2709
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-9606
  • Fax:
Mailing address:
  • Phone: 805-262-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH63389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: