Provider Demographics
NPI:1417006446
Name:AVEDIKYAN, SETA KULAK (RPH)
Entity Type:Individual
Prefix:
First Name:SETA
Middle Name:KULAK
Last Name:AVEDIKYAN
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 1:8415 RESEDA BLVD SUITE 6
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4684
Mailing Address - Country:US
Mailing Address - Phone:818-700-2956
Mailing Address - Fax:818-700-0513
Practice Address - Street 1:8415 RESEDA BLVD SUITE 6
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4684
Practice Address - Country:US
Practice Address - Phone:818-700-2956
Practice Address - Fax:818-700-0513
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY39069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA390690Medicaid
1108770001Medicare ID - Type Unspecified