Provider Demographics
NPI:1295160877
Name:EZRA, NAGHMEH NICOLE (RPH)
Entity type:Individual
Prefix:
First Name:NAGHMEH
Middle Name:NICOLE
Last Name:EZRA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5238 BECKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3102
Mailing Address - Country:US
Mailing Address - Phone:818-388-1587
Mailing Address - Fax:
Practice Address - Street 1:17864 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3615
Practice Address - Country:US
Practice Address - Phone:818-345-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist