Provider Demographics
NPI:1437434883
Name:ASSADOURIAN, MISSAK (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:MISSAK
Middle Name:
Last Name:ASSADOURIAN
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 1:3547 MEVEL PL
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1143
Mailing Address - Country:US
Mailing Address - Phone:818-389-5830
Mailing Address - Fax:
Practice Address - Street 1:3001 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-2714
Practice Address - Country:US
Practice Address - Phone:818-541-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist