MEDICARE: LILIT HAYTAIAN

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	66235	CA

General Provider Information

NPI Number	:	1922378645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIT HAYTAIAN

Provider Business Mailing Address
First Line	:	2195 GLENDALE GALLERIA
Second Line	:	T-2307
City	:	GLENDALE
State	:	CA
Zip	:	91210-2101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 GLENDALE GALLERIA
Second Line	:	T-2307
City	:	GLENDALE
State	:	CA
Zip	:	91210-2101
Country	:	US
Telephone Number	:	818-334-1401
Fax Number	:

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

Provider Enumeration Date	:	01/11/2012
Last Update Date	:	01/11/2012

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Directions to “ LILIT HAYTAIAN ” Practice Location

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