Provider Demographics
NPI:1417705286
Name:ISAYAN, TADEH PATRICK (PHARMD)
Entity type:Individual
Prefix:
First Name:TADEH
Middle Name:PATRICK
Last Name:ISAYAN
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 1:8444 DAY ST
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-3253
Mailing Address - Country:US
Mailing Address - Phone:818-731-9998
Mailing Address - Fax:
Practice Address - Street 1:2532 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-1934
Practice Address - Country:US
Practice Address - Phone:818-731-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist