MEDICARE: DAVID CELNIK D.PH

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	27778	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0574079	OTHER	CA	NABP
2	PHA221410	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1780673426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CELNIK D.PH

Provider Business Mailing Address
First Line	:	12925 MAGNOLIA BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-1618
Country	:	US
Telephone Number	:	818-783-6100
Fax Number	:	818-783-9780

Provider Business Practice Location Address
First Line	:	12925 MAGNOLIA BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-1618
Country	:	US
Telephone Number	:	818-783-6100
Fax Number	:	818-783-9780

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

Provider Enumeration Date	:	10/15/2005
Last Update Date	:	07/08/2007

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