Healthcare Provider Details

I. General information

NPI: 1124682802
Provider Name (Legal Business Name): ZOHRAB KHACHERYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 04/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 VERDUGO BLVD
MONTROSE CA
91020-1626
US

IV. Provider business mailing address

2037 VERDUGO BLVD
MONTROSE CA
91020-1626
US

V. Phone/Fax

Practice location:
  • Phone: 323-333-4074
  • Fax:
Mailing address:
  • Phone: 818-248-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: