Healthcare Provider Details

I. General information

NPI: 1255050092
Provider Name (Legal Business Name): SHANON VARTANIAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 SAN PABLO ST STE 144
LOS ANGELES CA
90033-5394
US

IV. Provider business mailing address

1510 SAN PABLO ST STE 144
LOS ANGELES CA
90033-5394
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5992
  • Fax:
Mailing address:
  • Phone: 323-442-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number86458
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: