Healthcare Provider Details

I. General information

NPI: 1194435479
Provider Name (Legal Business Name): MARYAM JALILI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 W SUNSET BLVD
WEST HOLLYWOOD CA
90046-3409
US

IV. Provider business mailing address

14957 ARCHWOOD ST
VAN NUYS CA
91405-4502
US

V. Phone/Fax

Practice location:
  • Phone: 323-512-0268
  • Fax: 323-512-7953
Mailing address:
  • Phone: 818-825-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87359
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number87359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: