Provider Demographics
NPI:1467219188
Name:MENEDZHYAN, SARKIS SAM
Entity Type:Individual
Prefix:
First Name:SARKIS
Middle Name:SAM
Last Name:MENEDZHYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7919 BELLINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2305
Mailing Address - Country:US
Mailing Address - Phone:818-807-7999
Mailing Address - Fax:
Practice Address - Street 1:2315 KUEHNER DR STE 107
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3960
Practice Address - Country:US
Practice Address - Phone:805-770-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist