Provider Demographics
NPI:1629777560
Name:OHANESIAN, GARY CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:CHARLES
Last Name:OHANESIAN
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 1:1221 S CLOVIS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5316
Mailing Address - Country:US
Mailing Address - Phone:559-681-8133
Mailing Address - Fax:
Practice Address - Street 1:5740 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5006
Practice Address - Country:US
Practice Address - Phone:559-431-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629013834OtherNPI NUMBER