Healthcare Provider Details

I. General information

NPI: 1073084539
Provider Name (Legal Business Name): JACQUELINE HOVHANESSIAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 WILSHIRE BLVD STE 2240
LOS ANGELES CA
90048-4935
US

IV. Provider business mailing address

5200 WHITE OAK AVE UNIT 52
ENCINO CA
91316-4518
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3457
  • Fax:
Mailing address:
  • Phone: 818-512-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: