Provider Demographics
NPI:1811450257
Name:MOCADAM, MICHAEL (PHARM D)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MOCADAM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 ETIWANDA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3639
Mailing Address - Country:US
Mailing Address - Phone:818-996-9906
Mailing Address - Fax:
Practice Address - Street 1:5525 ETIWANDA AVE STE 100
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3639
Practice Address - Country:US
Practice Address - Phone:818-996-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist