Healthcare Provider Details

I. General information

NPI: 1467092023
Provider Name (Legal Business Name): KAREN OHANESSIAN PHAMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2020
Last Update Date: 01/12/2020
Certification Date: 01/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

IV. Provider business mailing address

18417 TUBA ST
NORTHRIDGE CA
91325-1039
US

V. Phone/Fax

Practice location:
  • Phone: 747-210-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: