Healthcare Provider Details

I. General information

NPI: 1437744802
Provider Name (Legal Business Name): PATRICK MIRZAKHANIAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2021
Last Update Date: 03/07/2021
Certification Date: 03/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W TEHACHAPI BLVD
TEHACHAPI CA
93561-2559
US

IV. Provider business mailing address

1760 GARDENA AVE UNIT 217
GLENDALE CA
91204-3507
US

V. Phone/Fax

Practice location:
  • Phone: 661-823-0163
  • Fax:
Mailing address:
  • Phone: 818-400-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: