Provider Demographics
NPI:1164012787
Name:OVASAPYAN, VAHAGN (PHAM D)
Entity Type:Individual
Prefix:DR
First Name:VAHAGN
Middle Name:
Last Name:OVASAPYAN
Suffix:
Gender:M
Credentials:PHAM D
Other - Prefix:DR
Other - First Name:VAHAGN
Other - Middle Name:
Other - Last Name:OVASAPYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2419 E AVENUE S
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-6202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2419 E AVENUE S
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-6202
Practice Address - Country:US
Practice Address - Phone:661-274-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist