Provider Demographics
NPI:1518336775
Name:ZADIKIAN, NELLA
Entity Type:Individual
Prefix:
First Name:NELLA
Middle Name:
Last Name:ZADIKIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 PARK CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6207
Mailing Address - Country:US
Mailing Address - Phone:805-578-3305
Mailing Address - Fax:805-578-3309
Practice Address - Street 1:2660 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6207
Practice Address - Country:US
Practice Address - Phone:805-578-3305
Practice Address - Fax:805-578-3309
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist