Healthcare Provider Details

I. General information

NPI: 1285141408
Provider Name (Legal Business Name): MICHAEL TAWADROS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: