Provider Demographics
NPI:1114539673
Name:KARAPETYAN, GARY KARAPET
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:KARAPET
Last Name:KARAPETYAN
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 1:1415 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1611
Mailing Address - Country:US
Mailing Address - Phone:818-388-8610
Mailing Address - Fax:
Practice Address - Street 1:1415 DOROTHY DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-1611
Practice Address - Country:US
Practice Address - Phone:818-388-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist