MEDICARE: NAREK DERHARTUNIAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	59733	CA

General Provider Information

NPI Number	:	1093132508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAREK DERHARTUNIAN PHARMD

Provider Business Mailing Address
First Line	:	1025 E. BROADWAY
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1724
Country	:	US
Telephone Number	:	818-551-0082
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 E BROADWAY
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1205
Country	:	US
Telephone Number	:	818-551-0082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	04/08/2022

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