Healthcare Provider Details

I. General information

NPI: 1295975860
Provider Name (Legal Business Name): KRISTINE GEVORKYAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13652 CANTARA ST
PANORAMA CITY CA
91402-5423
US

IV. Provider business mailing address

1457 RAYMOND AVE
GLENDALE CA
91201-1277
US

V. Phone/Fax

Practice location:
  • Phone: 818-375-3288
  • Fax:
Mailing address:
  • Phone: 818-247-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH49806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: