MEDICARE: LIANA GEVORGYAN

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	85399	CA

General Provider Information

NPI Number	:	1154084036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANA GEVORGYAN

Provider Business Mailing Address
First Line	:	6726 SYLMAR AVE APT 106
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91405-5137
Country	:	US
Telephone Number	:	818-517-4642
Fax Number	:

Provider Business Practice Location Address
First Line	:	647 FOOTHILL BLVD
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-3403
Country	:	US
Telephone Number	:	818-790-5577
Fax Number	:

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

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	10/18/2021

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Directions to “ LIANA GEVORGYAN ” Practice Location

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