Provider Demographics
NPI:1740696038
Name:BEZIKIAN, MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BEZIKIAN
Suffix:
Gender:M
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:PO BOX 173
Mailing Address - Street 2:2100 MONTROSE AVE.
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91021-0173
Mailing Address - Country:US
Mailing Address - Phone:661-702-6911
Mailing Address - Fax:
Practice Address - Street 1:29675 THE OLD RD
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-4570
Practice Address - Country:US
Practice Address - Phone:661-702-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA71017OtherCA STATE BOARD OF PHARMACY