Provider Demographics
NPI:1225820475
Name:ANIS, TAKLA RAFAT (PHARMD)
Entity type:Individual
Prefix:
First Name:TAKLA
Middle Name:RAFAT
Last Name:ANIS
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 1:25415 DRY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3328
Mailing Address - Country:US
Mailing Address - Phone:818-809-9032
Mailing Address - Fax:
Practice Address - Street 1:23845 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2083
Practice Address - Country:US
Practice Address - Phone:661-200-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist