MEDICARE: DR. HAIGOUHI DOURGOUTIAN PHARMD

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	54500	CA

General Provider Information

NPI Number	:	1508850025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAIGOUHI DOURGOUTIAN PHARMD

Provider Business Mailing Address
First Line	:	7257 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-3409
Country	:	US
Telephone Number	:	323-512-0268
Fax Number	:

Provider Business Practice Location Address
First Line	:	7257 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-3409
Country	:	US
Telephone Number	:	323-512-0268
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	05/15/2012

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