Healthcare Provider Details

I. General information

NPI: 1023829934
Provider Name (Legal Business Name): HAKOP PETROSYAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 W MAGNOLIA BLVD UNIT B
BURBANK CA
91506-1738
US

IV. Provider business mailing address

2412 W MAGNOLIA BLVD UNIT B
BURBANK CA
91506-1738
US

V. Phone/Fax

Practice location:
  • Phone: 818-869-9997
  • Fax: 747-283-1265
Mailing address:
  • Phone: 818-869-9997
  • Fax: 747-283-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: