Provider Demographics
NPI:1700405750
Name:EDINJIKLIAN, TANYA MADELEIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MADELEIN
Last Name:EDINJIKLIAN
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 1:12415 STAGG ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2201
Mailing Address - Country:US
Mailing Address - Phone:818-388-8623
Mailing Address - Fax:
Practice Address - Street 1:4744 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1833
Practice Address - Country:US
Practice Address - Phone:818-505-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist