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General NPI Number Information
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NPI Number | 1710663299
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Entity Type | Individual
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Provider Name | MKRTICH MICHAEL KIRAKOSSIAN RPH
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Gender | Male
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 11177 TAMPA AVE STE B
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City | PORTER RANCH
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State | CA
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Zip | 91326-2254
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Country | US
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Telephone | 818-350-3998
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Fax |
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Provider Business Mailing Address
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Address Line | 151 N SWALL DR APT 2
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1913
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Country | US
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Telephone | 949-275-4743
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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 | RPH81599
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License Number State | CA
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