MEDICARE: MELINEH NAZARI RPH

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH56098	CA

General Provider Information

NPI Number	:	1639830839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINEH NAZARI RPH

Provider Business Mailing Address
First Line	:	366 W CALIFORNIA AVE APT 12
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-2245
Country	:	US
Telephone Number	:	818-913-5477
Fax Number	:

Provider Business Practice Location Address
First Line	:	366 W CALIFORNIA AVE APT 12
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-2245
Country	:	US
Telephone Number	:	818-913-5477
Fax Number	:

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

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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