Provider Demographics
NPI:1295012706
Name:ANDERSON, MEGAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ANDERSON
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 1:17401 VENTURA BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3861
Mailing Address - Country:US
Mailing Address - Phone:747-247-6604
Mailing Address - Fax:747-272-1969
Practice Address - Street 1:17401 VENTURA BLVD STE A1
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3861
Practice Address - Country:US
Practice Address - Phone:747-247-6604
Practice Address - Fax:747-272-1969
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist