Provider Demographics
NPI:1114502648
Name:TAKLA, PETER F (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:F
Last Name:TAKLA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17620 BELLFLOWER BLVD STE B104
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-8001
Mailing Address - Country:US
Mailing Address - Phone:562-804-0101
Mailing Address - Fax:562-804-0099
Practice Address - Street 1:17620 BELLFLOWER BLVD STE B104
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-8001
Practice Address - Country:US
Practice Address - Phone:562-804-0101
Practice Address - Fax:562-804-0099
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH71996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist