Provider Demographics
NPI:1316534951
Name:GEZALIAN, TIGRAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIGRAN
Middle Name:
Last Name:GEZALIAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 W AVENUE N
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2989
Mailing Address - Country:US
Mailing Address - Phone:661-722-5892
Mailing Address - Fax:661-943-8062
Practice Address - Street 1:5001 W AVENUE N
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-2989
Practice Address - Country:US
Practice Address - Phone:661-722-5892
Practice Address - Fax:661-943-8062
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83548183500000X
CARPH83548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist