MEDICARE: DR. NARE PETOYAN PHARM D.

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	756985	CA

General Provider Information

NPI Number	:	1386172963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NARE PETOYAN PHARM D.

Provider Business Mailing Address
First Line	:	1611 GLENMONT DR
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91207-1007
Country	:	US
Telephone Number	:	818-399-2949
Fax Number	:

Provider Business Practice Location Address
First Line	:	18455 BURBANK BLVD STE 311
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-6647
Country	:	US
Telephone Number	:	818-570-2002
Fax Number	:	818-570-2003

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

Provider Enumeration Date	:	05/26/2017
Last Update Date	:	11/24/2020

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