Healthcare Provider Details

I. General information

NPI: 1134311921
Provider Name (Legal Business Name): ANNA GEVORKYAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 W BROADWAY
GLENDALE CA
91204-1208
US

IV. Provider business mailing address

7452 VALAHO LN
TUJUNGA CA
91042-2658
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-5996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: