Healthcare Provider Details

I. General information

NPI: 1669991048
Provider Name (Legal Business Name): MANE VAZGENOVNA BAGHIKIAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2017
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 W SUNSET BLVD STE 6122
LOS ANGELES CA
90027-5822
US

IV. Provider business mailing address

400 N 6TH ST APT 101
BURBANK CA
91501-1962
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-4052
  • Fax:
Mailing address:
  • Phone: 818-378-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: