Provider Demographics
NPI:1598537086
Name:MKRTCHIAN, VARDGES
Entity Type:Individual
Prefix:
First Name:VARDGES
Middle Name:
Last Name:MKRTCHIAN
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 1:2505 MONTROSE AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-2237
Mailing Address - Country:US
Mailing Address - Phone:818-284-5625
Mailing Address - Fax:
Practice Address - Street 1:421 W ESPLANADE DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1298
Practice Address - Country:US
Practice Address - Phone:805-278-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist