Provider Demographics
NPI:1245072685
Name:PAMANIAN, EDWARD WILLIAM ILDEFONSO (PHARMD)
Entity type:Individual
Prefix:
First Name:EDWARD WILLIAM
Middle Name:ILDEFONSO
Last Name:PAMANIAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:ILDEFONSO
Other - Last Name:PAMANIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:21910 ROSCOE BLVD APT 210
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3965
Mailing Address - Country:US
Mailing Address - Phone:818-271-7290
Mailing Address - Fax:
Practice Address - Street 1:11300 MING AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1300
Practice Address - Country:US
Practice Address - Phone:661-664-0187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist