Healthcare Provider Details

I. General information

NPI: 1609708890
Provider Name (Legal Business Name): EDITA KYURKCHYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDITA MARTIROSYAN

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 COLDWATER CANYON AVE APT 203
STUDIO CITY CA
91604-1025
US

IV. Provider business mailing address

4551 COLDWATER CANYON AVE APT 203
STUDIO CITY CA
91604-1025
US

V. Phone/Fax

Practice location:
  • Phone: 310-330-6455
  • Fax:
Mailing address:
  • Phone: 310-330-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS70489
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: