Healthcare Provider Details

I. General information

NPI: 1700136967
Provider Name (Legal Business Name): KLEONIKI F GUZELYAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 N. COMMONWEALTH AVE 1
LOS ANGELES CA
90027
US

IV. Provider business mailing address

2024 N COMMONWEALTH AVE APT 1
LOS ANGELES CA
90027-2839
US

V. Phone/Fax

Practice location:
  • Phone: 323-666-9302
  • Fax:
Mailing address:
  • Phone: 323-666-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: