Healthcare Provider Details

I. General information

NPI: 1912555707
Provider Name (Legal Business Name): EMIL HOVHANNISYAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 10/30/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10049 GOTHIC AVE
NORTH HILLS CA
91343-1211
US

IV. Provider business mailing address

12117 SATICOY ST.
NORTH HOLLYWOOD CA
91605
US

V. Phone/Fax

Practice location:
  • Phone: 818-653-0338
  • Fax:
Mailing address:
  • Phone: 747-277-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: