Provider Demographics
NPI:1710968235
Name:MELAMED, HOOTAN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:HOOTAN
Middle Name:
Last Name:MELAMED
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 CENTURY PARK LN
Mailing Address - Street 2:#404
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-3307
Mailing Address - Country:US
Mailing Address - Phone:310-666-1397
Mailing Address - Fax:310-388-5437
Practice Address - Street 1:2132 CENTURY PARK LN
Practice Address - Street 2:#404
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-3307
Practice Address - Country:US
Practice Address - Phone:310-666-1397
Practice Address - Fax:310-388-5437
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH56634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist