Provider Demographics
NPI:1083107775
Name:PEZESHK, ROXANNE SARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:SARA
Last Name:PEZESHK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 WILSHIRE BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1733
Mailing Address - Country:US
Mailing Address - Phone:310-478-0801
Mailing Address - Fax:
Practice Address - Street 1:300 N CANON DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4705
Practice Address - Country:US
Practice Address - Phone:310-276-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist