Provider Demographics
NPI:1801117767
Name:DOLIN, MYRON ALAN (RPH)
Entity type:Individual
Prefix:
First Name:MYRON
Middle Name:ALAN
Last Name:DOLIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3610
Mailing Address - Country:US
Mailing Address - Phone:818-891-6785
Mailing Address - Fax:818-893-8108
Practice Address - Street 1:8400 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3610
Practice Address - Country:US
Practice Address - Phone:818-891-6785
Practice Address - Fax:818-893-8108
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist