Healthcare Provider Details

I. General information

NPI: 1306579131
Provider Name (Legal Business Name): KRISTINE ADZHEMYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S FETTERLY AVE
LOS ANGELES CA
90022-1605
US

IV. Provider business mailing address

5110 WHITSETT AVE APT 103
VALLEY VILLAGE CA
91607-3085
US

V. Phone/Fax

Practice location:
  • Phone: 323-362-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number85387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: