Provider Demographics
NPI:1396029617
Name:KESHISHIAN, VIGEN
Entity Type:Individual
Prefix:MR
First Name:VIGEN
Middle Name:
Last Name:KESHISHIAN
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 1:17800 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1200
Mailing Address - Country:US
Mailing Address - Phone:561-981-5003
Mailing Address - Fax:561-981-5024
Practice Address - Street 1:17800 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1200
Practice Address - Country:US
Practice Address - Phone:561-981-5003
Practice Address - Fax:561-981-5024
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS029421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist