Provider Demographics
NPI:1740778737
Name:NOROUZZADEH, MARJAN
Entity type:Individual
Prefix:
First Name:MARJAN
Middle Name:
Last Name:NOROUZZADEH
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 1:57545 YUCCA TRL APT 6
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3871
Mailing Address - Country:US
Mailing Address - Phone:818-825-7168
Mailing Address - Fax:
Practice Address - Street 1:58501 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5765
Practice Address - Country:US
Practice Address - Phone:760-365-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist