MEDICARE: MIHRAN DERMENJIAN PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH44461	CA

General Provider Information

NPI Number	:	1043952914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIHRAN DERMENJIAN PHARM.D.

Provider Business Mailing Address
First Line	:	4030 KAREN LYNN DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-1222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 S CENTRAL AVE STE 117
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-4325
Country	:	US
Telephone Number	:	818-956-1577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	04/11/2022

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Directions to “ MIHRAN DERMENJIAN PHARM.D.” Practice Location

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