Provider Demographics
NPI:1396826178
Name:GEVORKYAN, ANNA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:GEVORKYAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W SAMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1419
Mailing Address - Country:US
Mailing Address - Phone:559-261-9623
Mailing Address - Fax:
Practice Address - Street 1:2484 E GETTYSBURG AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0322
Practice Address - Country:US
Practice Address - Phone:559-222-6276
Practice Address - Fax:559-222-4388
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist