Provider Demographics
NPI:1316599905
Name:YEGIAZARYAN, HARRY HRAIR
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:HRAIR
Last Name:YEGIAZARYAN
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 1:1776 N HARVARD BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-3623
Mailing Address - Country:US
Mailing Address - Phone:323-604-9230
Mailing Address - Fax:
Practice Address - Street 1:1776 N HARVARD BLVD APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3623
Practice Address - Country:US
Practice Address - Phone:323-604-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist