Healthcare Provider Details

I. General information

NPI: 1801184783
Provider Name (Legal Business Name): IRINA KAGAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 SEPULVEDA BLVD
VAN NUYS CA
91411-2918
US

IV. Provider business mailing address

16781 KNOLLWOOD DR
GRANADA HILLS CA
91344-2626
US

V. Phone/Fax

Practice location:
  • Phone: 818-779-0321
  • Fax:
Mailing address:
  • Phone: 818-642-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: