Provider Demographics
NPI:1508244005
Name:MARTIROSIAN, ANAIT
Entity Type:Individual
Prefix:DR
First Name:ANAIT
Middle Name:
Last Name:MARTIROSIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15040 SHERVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5036
Mailing Address - Country:US
Mailing Address - Phone:818-935-9877
Mailing Address - Fax:
Practice Address - Street 1:22915 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3533
Practice Address - Country:US
Practice Address - Phone:818-716-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH57638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist