Healthcare Provider Details

I. General information

NPI: 1922380716
Provider Name (Legal Business Name): GURGEN BAGDASARIAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 S GLENDALE AVE STE M
GLENDALE CA
91205-3273
US

IV. Provider business mailing address

1248 S GLENDALE AVE STE M
GLENDALE CA
91205-3273
US

V. Phone/Fax

Practice location:
  • Phone: 818-637-2177
  • Fax: 818-637-2831
Mailing address:
  • Phone: 818-637-2177
  • Fax: 818-637-2831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: