Provider Demographics
NPI:1073025508
Name:ZADOVA, ANNA (RPH)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ZADOVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13843 OXNARD ST APT 47
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-3937
Mailing Address - Country:US
Mailing Address - Phone:818-268-7024
Mailing Address - Fax:
Practice Address - Street 1:1822 E AVENIDA DE LOS ARBOLES
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-1303
Practice Address - Country:US
Practice Address - Phone:805-493-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist