Healthcare Provider Details

I. General information

NPI: 1740757061
Provider Name (Legal Business Name): MELINE TOUTIKIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25880 MCBEAN PKWY
VALENCIA CA
91355-2004
US

IV. Provider business mailing address

18923 BLACKHAWK ST
PORTER RANCH CA
91326-3313
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-3766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: