Provider Demographics
NPI:1366601577
Name:JALALIAN, SUSAN MIKHAELA
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MIKHAELA
Last Name:JALALIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 SANDRA PL
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4015
Mailing Address - Country:US
Mailing Address - Phone:650-219-7697
Mailing Address - Fax:650-251-9298
Practice Address - Street 1:2914 SANDRA PL
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4015
Practice Address - Country:US
Practice Address - Phone:650-219-7697
Practice Address - Fax:650-251-9298
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415771835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41577OtherPHARMACIST LICENSE NBR