MEDICARE: ELLEN MARIE AZIZIAN

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	84775	CA

General Provider Information

NPI Number	:	1548938079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN MARIE AZIZIAN

Provider Business Mailing Address
First Line	:	1515 GREENBRIAR RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91207-1535
Country	:	US
Telephone Number	:	818-625-1424
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 GREENBRIAR RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91207-1535
Country	:	US
Telephone Number	:	818-625-1424
Fax Number	:

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

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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Directions to “ ELLEN MARIE AZIZIAN ” Practice Location

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