Provider Demographics
NPI:1326387606
Name:ATTALLAH, IRENE AZER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:AZER
Last Name:ATTALLAH
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 1:17060 TENNYSON PL
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1232
Mailing Address - Country:US
Mailing Address - Phone:818-970-9404
Mailing Address - Fax:
Practice Address - Street 1:17060 TENNYSON PL
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-1232
Practice Address - Country:US
Practice Address - Phone:818-970-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist