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General NPI Number Information
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NPI Number | 1356764989
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Entity Type | Individual
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Provider Name | SEAN AGAZANOF PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 11301 W OLYMPIC BLVD NUMBER 434
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City | LOS ANGELES
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State | CA
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Zip | 90064-1653
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Country | US
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Telephone | 310-445-1529
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Fax |
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Provider Business Mailing Address
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Address Line | 11301 W OLYMPIC BLVD # 434
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City | LOS ANGELES
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State | CA
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Zip | 90064-1653
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 64232
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1835N0905X
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Taxonomy Name | Nuclear Pharmacist
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License Number | AU
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License Number State | IN
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