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General NPI Number Information
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NPI Number | 1245318559
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Entity Type | Individual
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Provider Name | MRS. JACKLIN KOHANSEDGH
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 18254 SHERMAN WAY
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City | RESEDA
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State | CA
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Zip | 91335
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Country | US
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Telephone | 818-708-7080
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Fax | 818-708-9142
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Provider Business Mailing Address
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Address Line | 5825 RESEDA BLVD #301
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City | TARZANA
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State | CA
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Zip | 91356
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Country | US
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Telephone | 818-388-8102
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Fax |
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | TCH30960
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License Number State | CA
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