MEDICARE: LISA KALAJIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	64194	CA

General Provider Information

NPI Number	:	1205763448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KALAJIAN

Provider Business Mailing Address
First Line	:	3028 CAPRI LN
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-3502
Country	:	US
Telephone Number	:	626-705-2509
Fax Number	:

Provider Business Practice Location Address
First Line	:	3028 CAPRI LN
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-3502
Country	:	US
Telephone Number	:	626-705-2509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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