Provider Demographics
NPI:1609187202
Name:QAZIZADA, MEENA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEENA
Middle Name:
Last Name:QAZIZADA
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 1:28056 MARGUERITE PKWY APT N
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3625
Mailing Address - Country:US
Mailing Address - Phone:949-413-3588
Mailing Address - Fax:
Practice Address - Street 1:2858 LOKER AVE E
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6666
Practice Address - Country:US
Practice Address - Phone:760-804-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64197183500000X
FL44987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist