Provider Demographics
NPI:1134448103
Name:DAVID, AZIN (PHARM D)
Entity type:Individual
Prefix:
First Name:AZIN
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
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 1:18220 SUGARMAN ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4324
Mailing Address - Country:US
Mailing Address - Phone:818-294-2881
Mailing Address - Fax:
Practice Address - Street 1:20141 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306-3206
Practice Address - Country:US
Practice Address - Phone:818-882-0202
Practice Address - Fax:818-882-4846
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist