=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366936262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEANNA ZADOROZNY PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2018
-----------------------------------------------------
Last Update Date | 07/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11165 SEPULVEDA BLVD
-----------------------------------------------------
City | MISSION HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91345-1113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-837-5592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11201 OTSEGO ST APT 412
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91601-3779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-459-1160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | 77890
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 77890
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------