Provider Demographics
NPI:1689956039
Name:SIAZON, GERALD (PHARM D)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SIAZON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20901 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2313
Mailing Address - Country:US
Mailing Address - Phone:818-341-4339
Mailing Address - Fax:818-341-4713
Practice Address - Street 1:20901 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2313
Practice Address - Country:US
Practice Address - Phone:818-341-4339
Practice Address - Fax:818-341-4713
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist