MEDICARE: HARUTYUN KAGOYAN 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	64527	CA

General Provider Information

NPI Number	:	1649767641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARUTYUN KAGOYAN PHARMD.

Provider Business Mailing Address
First Line	:	14147 GAULT ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91405-3261
Country	:	US
Telephone Number	:	818-648-4427
Fax Number	:

Provider Business Practice Location Address
First Line	:	7640 TAMPA AVE STE E
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-1700
Country	:	US
Telephone Number	:	818-578-7400
Fax Number	:

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

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	04/16/2018

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