Provider Demographics
NPI:1114686912
Name:MANANYAN GYULBEKYAN, MARINE (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:MARINE
Middle Name:
Last Name:MANANYAN GYULBEKYAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2133
Mailing Address - Country:US
Mailing Address - Phone:818-600-0777
Mailing Address - Fax:
Practice Address - Street 1:839 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2133
Practice Address - Country:US
Practice Address - Phone:818-600-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist