Provider Demographics
NPI:1598766271
Name:TATEVOSSIAN, ARMEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ARMEN
Middle Name:
Last Name:TATEVOSSIAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19500 PLUMMER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2144
Mailing Address - Country:US
Mailing Address - Phone:818-701-7777
Mailing Address - Fax:818-700-4510
Practice Address - Street 1:19500 PLUMMER ST
Practice Address - Street 2:SUITE C
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2144
Practice Address - Country:US
Practice Address - Phone:818-701-7777
Practice Address - Fax:818-700-4510
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0578015OtherNABP NUMBER
CAPHY432720Medicaid
CA0578015OtherNABP NUMBER