Provider Demographics
NPI:1588665087
Name:VAKO MINAS AGAJANIAN
Entity Type:Organization
Organization Name:VAKO MINAS AGAJANIAN
Other - Org Name:AKHTAMAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAJANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-817-9828
Mailing Address - Street 1:1729 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2752
Mailing Address - Country:US
Mailing Address - Phone:626-817-9828
Mailing Address - Fax:626-817-9830
Practice Address - Street 1:1729 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2752
Practice Address - Country:US
Practice Address - Phone:626-817-9828
Practice Address - Fax:626-817-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153993OtherPK
CA5544370001Medicare NSC