MEDICARE: DR. ANIE TATAVOS-GHARAJEH PHARM. D

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	RPH56100	CA

General Provider Information

NPI Number	:	1750682977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANIE TATAVOS-GHARAJEH PHARM. D

Provider Business Mailing Address
First Line	:	16830 SAN FERNANDO MISSION BLVD
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4247
Country	:	US
Telephone Number	:	818-831-5059
Fax Number	:

Provider Business Practice Location Address
First Line	:	16830 SAN FERNANDO MISSION BLVD
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-4247
Country	:	US
Telephone Number	:	818-831-5059
Fax Number	:

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/04/2010

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