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General NPI Number Information
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NPI Number | 1114502648
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Entity Type | Individual
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Provider Name | PETER F TAKLA PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 17620 BELLFLOWER BLVD STE B104
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City | BELLFLOWER
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State | CA
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Zip | 90706-8001
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Country | US
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Telephone | 562-804-0101
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Fax | 562-804-0099
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Provider Business Mailing Address
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Address Line | 17620 BELLFLOWER BLVD STE B104
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City | BELLFLOWER
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State | CA
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Zip | 90706-8001
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Country | US
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Telephone | 562-804-0101
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Fax | 562-804-0099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH71996
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License Number State | CA
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