Provider Demographics
NPI:1396382438
Name:ELEASIYAN, HYIBIRD
Entity Type:Individual
Prefix:DR
First Name:HYIBIRD
Middle Name:
Last Name:ELEASIYAN
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 1:1424 LEE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1142
Mailing Address - Country:US
Mailing Address - Phone:818-653-7251
Mailing Address - Fax:
Practice Address - Street 1:1424 LEE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1142
Practice Address - Country:US
Practice Address - Phone:818-653-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist