Provider Demographics
NPI:1629442496
Name:ARMANIOUS, WASSIM
Entity Type:Individual
Prefix:
First Name:WASSIM
Middle Name:
Last Name:ARMANIOUS
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 1:14211 DICKENS STREET
Mailing Address - Street 2:APT 9
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423
Mailing Address - Country:US
Mailing Address - Phone:818-723-3250
Mailing Address - Fax:
Practice Address - Street 1:14211 DICKENS ST
Practice Address - Street 2:APT 9
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-4171
Practice Address - Country:US
Practice Address - Phone:818-723-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist