MEDICARE: KARINE TAGLYAN

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	47137	CA

General Provider Information

NPI Number	:	1760129134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINE TAGLYAN

Provider Business Mailing Address
First Line	:	5236 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1210
Country	:	US
Telephone Number	:	323-661-7152
Fax Number	:

Provider Business Practice Location Address
First Line	:	5236 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1210
Country	:	US
Telephone Number	:	323-661-7152
Fax Number	:

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

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/21/2022

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