Provider Demographics
NPI:1962762468
Name:MIRZATUNY, HERSELA (PHARM D)
Entity type:Individual
Prefix:MS
First Name:HERSELA
Middle Name:
Last Name:MIRZATUNY
Suffix:
Gender:F
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 1:26836 OSO PKWY APT 2204
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6053
Mailing Address - Country:US
Mailing Address - Phone:818-804-1365
Mailing Address - Fax:
Practice Address - Street 1:26836 OSO PKWY APT 2204
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6053
Practice Address - Country:US
Practice Address - Phone:818-804-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist