Provider Demographics
NPI:1770314627
Name:MEDIZADE, ARIANA I (PHARMD)
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:I
Last Name:MEDIZADE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ARROWHEAD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-8842
Mailing Address - Country:US
Mailing Address - Phone:805-550-0006
Mailing Address - Fax:
Practice Address - Street 1:19 ARROWHEAD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-8842
Practice Address - Country:US
Practice Address - Phone:805-550-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist