Provider Demographics
NPI:1114641511
Name:CHOLOKYAN, ALEXANDER SERGE
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SERGE
Last Name:CHOLOKYAN
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 1:230 12TH AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2162
Mailing Address - Country:US
Mailing Address - Phone:415-680-0351
Mailing Address - Fax:
Practice Address - Street 1:850 LA PLAYA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3219
Practice Address - Country:US
Practice Address - Phone:415-680-0351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF2879508OtherDMV