Healthcare Provider Details

I. General information

NPI: 1609092782
Provider Name (Legal Business Name): LIOUBOV TCHASOV PHARMACY TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18356 OXNARD ST STE 1
TARZANA CA
91356-6706
US

IV. Provider business mailing address

18356 OXNARD ST STE 1
TARZANA CA
91356-6706
US

V. Phone/Fax

Practice location:
  • Phone: 818-343-3443
  • Fax: 818-343-0933
Mailing address:
  • Phone: 818-343-3443
  • Fax: 818-343-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number71770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: