=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972058600
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARINE ZATIKIAN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2016
-----------------------------------------------------
Last Update Date | 08/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1208 W MAGNOLIA BLVD
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-1830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-260-0010
-----------------------------------------------------
Fax | 888-641-7979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2528 N VERMONT AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-1243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-713-6600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 60091
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------