Healthcare Provider Details

I. General information

NPI: 1003448796
Provider Name (Legal Business Name): MADLEN BASILYAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7057 FOOTHILL BLVD
TUJUNGA CA
91042-2714
US

IV. Provider business mailing address

7057 FOOTHILL BLVD
TUJUNGA CA
91042-2714
US

V. Phone/Fax

Practice location:
  • Phone: 818-875-4158
  • Fax: 818-875-4159
Mailing address:
  • Phone: 818-875-4158
  • Fax: 818-875-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: