Provider Demographics
NPI:1093120180
Name:JAVAHERIAN, EMAN
Entity Type:Individual
Prefix:
First Name:EMAN
Middle Name:
Last Name:JAVAHERIAN
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 1:17441 HATTERAS ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1313
Mailing Address - Country:US
Mailing Address - Phone:818-421-1373
Mailing Address - Fax:
Practice Address - Street 1:17441 HATTERAS ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1313
Practice Address - Country:US
Practice Address - Phone:818-421-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist