Provider Demographics
NPI:1750674685
Name:BLIEDEN, CARLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BLIEDEN
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 1:6744 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5532
Mailing Address - Country:US
Mailing Address - Phone:818-854-1347
Mailing Address - Fax:818-787-7256
Practice Address - Street 1:6744 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-5532
Practice Address - Country:US
Practice Address - Phone:818-854-1347
Practice Address - Fax:818-787-7256
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist