Provider Demographics
NPI:1386042414
Name:FABIAN, CHRISJON AYEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISJON
Middle Name:AYEN
Last Name:FABIAN
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 1:12113 SHADOW RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3826
Mailing Address - Country:US
Mailing Address - Phone:818-667-4271
Mailing Address - Fax:
Practice Address - Street 1:7015 N WEST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0461
Practice Address - Country:US
Practice Address - Phone:559-440-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist