Provider Demographics
NPI:1417510801
Name:VARZHAPETYAN, PARGEV (PHARM D)
Entity Type:Individual
Prefix:
First Name:PARGEV
Middle Name:
Last Name:VARZHAPETYAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2002
Mailing Address - Country:US
Mailing Address - Phone:818-281-6165
Mailing Address - Fax:
Practice Address - Street 1:13021 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2925
Practice Address - Country:US
Practice Address - Phone:818-760-2861
Practice Address - Fax:818-760-0644
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist