Provider Demographics
NPI:1215362199
Name:KANAYAN, ELEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELEN
Middle Name:
Last Name:KANAYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W DRYDEN ST APT 18
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2339
Mailing Address - Country:US
Mailing Address - Phone:818-726-4579
Mailing Address - Fax:
Practice Address - Street 1:3001 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2714
Practice Address - Country:US
Practice Address - Phone:181-854-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist