Healthcare Provider Details

I. General information

NPI: 1851793343
Provider Name (Legal Business Name): SEVAK OLMESSEKIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N. MARYLAND AVE. SUITE 307
GLENDALE CA
91206
US

IV. Provider business mailing address

230 N. MARYLAND AVE. SUITE 307
GLENDALE CA
91206
US

V. Phone/Fax

Practice location:
  • Phone: 888-884-6337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH53157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: