Provider Demographics
NPI:1033639240
Name:SHARYAN, VACHE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VACHE
Middle Name:
Last Name:SHARYAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E STOCKER ST APT 302
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1302
Mailing Address - Country:US
Mailing Address - Phone:818-822-7977
Mailing Address - Fax:
Practice Address - Street 1:1505 WILSON TER STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4073
Practice Address - Country:US
Practice Address - Phone:818-822-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76340183500000X, 1835P1200X, 1835P2201X, 1835X0200X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835X0200XPharmacy Service ProvidersPharmacistOncology