Provider Demographics
NPI:1407039886
Name:AVANESYAN, SARGIS (RPH)
Entity Type:Individual
Prefix:
First Name:SARGIS
Middle Name:
Last Name:AVANESYAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 ALAMO ST
Mailing Address - Street 2:KAISER PERMANENTE SIMI VALLEY PHARMACY
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-2111
Mailing Address - Country:US
Mailing Address - Phone:818-582-3006
Mailing Address - Fax:805-582-3086
Practice Address - Street 1:3900 ALAMO ST
Practice Address - Street 2:KAISER PERMANENTE SIMI VALLEY PHARMACY
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2111
Practice Address - Country:US
Practice Address - Phone:818-582-3006
Practice Address - Fax:805-582-3086
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-09
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist