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General NPI Number Information
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NPI Number | 1114686912
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Entity Type | Individual
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Provider Name | MARINE MANANYAN GYULBEKYAN PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 839 W GLENOAKS BLVD
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City | GLENDALE
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State | CA
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Zip | 91202-2133
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Country | US
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Telephone | 818-600-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 839 W GLENOAKS BLVD
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City | GLENDALE
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State | CA
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Zip | 91202-2133
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Country | US
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Telephone | 818-600-0777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 80705
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License Number State | CA
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