Provider Demographics
NPI:1528582715
Name:PANOSYAN, HERMINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:HERMINE
Middle Name:
Last Name:PANOSYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E ELK AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1787
Mailing Address - Country:US
Mailing Address - Phone:818-653-5642
Mailing Address - Fax:
Practice Address - Street 1:140 N SAN FERNANDO BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1207
Practice Address - Country:US
Practice Address - Phone:818-859-7179
Practice Address - Fax:818-859-7278
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist