Healthcare Provider Details

I. General information

NPI: 1972767150
Provider Name (Legal Business Name): MISS EVA BANDIKIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 E CHEVY CHASE DR
GLENDALE CA
91205-2511
US

IV. Provider business mailing address

PO BOX 424
VAN NUYS CA
91408-0424
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-1731
  • Fax:
Mailing address:
  • Phone: 818-312-0998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH29922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: