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General NPI Number Information
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NPI Number | 1558675710
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Entity Type | Individual
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Provider Name | MRS. JAQUELYN MANOUGIAN
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Gender | Female
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 6700 TOPANGA CANYON BLVD
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City | CANOGA PARK
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State | CA
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Zip | 91303-2624
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Country | US
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Telephone | 818-445-0226
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Fax |
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Provider Business Mailing Address
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Address Line | 12603 MOORPARK ST APT 106
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City | STUDIO CITY
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State | CA
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Zip | 91604-4559
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Country | US
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Telephone | 818-445-0226
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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 | 66025
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License Number State | CA
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