Provider Demographics
NPI:1083376248
Name:MUSHEGIAN, MICHAEL HAIK
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAIK
Last Name:MUSHEGIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S VIA MONTANA
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-1146
Mailing Address - Country:US
Mailing Address - Phone:818-859-3818
Mailing Address - Fax:
Practice Address - Street 1:25050 PEACHLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-5764
Practice Address - Country:US
Practice Address - Phone:661-255-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist