Healthcare Provider Details

I. General information

NPI: 1457802423
Provider Name (Legal Business Name): NAIRA GHAZARYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W ARTESIA BLVD
COMPTON CA
90220-5108
US

IV. Provider business mailing address

615 S ADAMS ST APT 12
GLENDALE CA
91205-5215
US

V. Phone/Fax

Practice location:
  • Phone: 310-884-9000
  • Fax:
Mailing address:
  • Phone: 818-303-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: