Healthcare Provider Details

I. General information

NPI: 1205535515
Provider Name (Legal Business Name): MELLINE AVANESIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

924 VERDUGO CIRCLE DR
GLENDALE CA
91206-1534
US

V. Phone/Fax

Practice location:
  • Phone: 323-423-2285
  • Fax:
Mailing address:
  • Phone: 818-640-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number86483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: