Provider Demographics
NPI:1356764989
Name:AGAZANOF, SEAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:AGAZANOF
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 1:11301 W OLYMPIC BLVD
Mailing Address - Street 2:# 434
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11301 W OLYMPIC BLVD
Practice Address - Street 2:NUMBER 434
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1653
Practice Address - Country:US
Practice Address - Phone:310-445-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64232183500000X
INAU1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64232OtherPHARMACY LICENSE NUMBER