Healthcare Provider Details

I. General information

NPI: 1932063021
Provider Name (Legal Business Name): GREGORY VAHE HOVHANESSIAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 EL CAMINO REAL
ATASCADERO CA
93422-5211
US

IV. Provider business mailing address

25409 VIA NAUTICA
VALENCIA CA
91355-2614
US

V. Phone/Fax

Practice location:
  • Phone: 805-462-9272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: