MEDICARE: MISS ANNA GEVORKYAN RPH

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	54132	CA

General Provider Information

NPI Number	:	1396826178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNA GEVORKYAN RPH

Provider Business Mailing Address
First Line	:	450 W SAMPLE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-1419
Country	:	US
Telephone Number	:	559-261-9623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2484 E GETTYSBURG AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-0322
Country	:	US
Telephone Number	:	559-222-6276
Fax Number	:	559-222-4388

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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