Provider Demographics
NPI:1205538857
Name:GOLZAR, TALA
Entity type:Individual
Prefix:
First Name:TALA
Middle Name:
Last Name:GOLZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 CANOGA AVE APT 230
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6648
Mailing Address - Country:US
Mailing Address - Phone:310-499-3230
Mailing Address - Fax:
Practice Address - Street 1:5525 CANOGA AVE APT 230
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6648
Practice Address - Country:US
Practice Address - Phone:310-499-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist