Provider Demographics
NPI:1326792102
Name:BAGDATYAN, ARUTYUN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ARUTYUN
Middle Name:
Last Name:BAGDATYAN
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 1:6740 MATILIJA AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4800
Mailing Address - Country:US
Mailing Address - Phone:818-987-9666
Mailing Address - Fax:
Practice Address - Street 1:12914B SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-4953
Practice Address - Country:US
Practice Address - Phone:818-358-4300
Practice Address - Fax:818-358-4399
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA72602OtherCALIFORNIA PHARMACY BOARD