Healthcare Provider Details

I. General information

NPI: 1649791435
Provider Name (Legal Business Name): KSENIA ARTEMENKO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18441 VENTURA BLVD
TARZANA CA
91356-4201
US

IV. Provider business mailing address

18441 VENTURA BLVD
TARZANA CA
91356-4201
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1000
  • Fax: 818-342-9032
Mailing address:
  • Phone: 818-996-1000
  • Fax: 818-342-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: