MEDICARE: IMAN FARAGALLA

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	52476	CA

General Provider Information

NPI Number	:	1699230227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMAN FARAGALLA

Provider Business Mailing Address
First Line	:	9900 SEPULVEDA BLVD
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-2916
Country	:	US
Telephone Number	:	818-892-4321
Fax Number	:	818-892-4214

Provider Business Practice Location Address
First Line	:	9900 SEPULVEDA BLVD
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-2916
Country	:	US
Telephone Number	:	818-892-4321
Fax Number	:	818-892-4214

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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Directions to “ IMAN FARAGALLA ” Practice Location

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