Healthcare Provider Details

I. General information

NPI: 1467115105
Provider Name (Legal Business Name): ARMEN AYVAZYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 LAUREL CANYON BLVD
ARLETA CA
91331-4100
US

IV. Provider business mailing address

630 E GARFIELD AVE APT 14
GLENDALE CA
91205-2970
US

V. Phone/Fax

Practice location:
  • Phone: 818-492-0025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: