Provider Demographics
NPI:1528605458
Name:CHLASIAN, HAYK DAVID
Entity Type:Individual
Prefix:
First Name:HAYK
Middle Name:DAVID
Last Name:CHLASIAN
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 1:430 W DRYDEN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2372
Mailing Address - Country:US
Mailing Address - Phone:818-632-9798
Mailing Address - Fax:
Practice Address - Street 1:1800 W EMPIRE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3403
Practice Address - Country:US
Practice Address - Phone:818-238-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist