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General NPI Number Information
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NPI Number | 1588665087
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Entity Type | Organization
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Legal Business Name | VAKO MINAS AGAJANIAN
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 1729 E WASHINGTON BLVD
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City | PASADENA
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State | CA
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Zip | 91104-2752
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Country | US
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Telephone | 626-817-9828
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Fax | 626-817-9830
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Provider Business Mailing Address
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Address Line | 1729 E WASHINGTON BLVD
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City | PASADENA
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State | CA
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Zip | 91104-2752
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Country | US
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Telephone | 626-817-9828
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Fax | 626-817-9830
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Authorized Official
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Title or Position | OWNER
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Name | VAKO AGAJANIAN
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Credential |
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Telephone | 626-817-9828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 53780
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License Number State | CA
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