Provider Demographics
NPI:1578335675
Name:OHANESYAN, MASIS (RPH)
Entity Type:Individual
Prefix:
First Name:MASIS
Middle Name:
Last Name:OHANESYAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9204 DELAIR WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4535
Mailing Address - Country:US
Mailing Address - Phone:818-334-7492
Mailing Address - Fax:
Practice Address - Street 1:4900 ELK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4188
Practice Address - Country:US
Practice Address - Phone:916-683-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88583333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy