Provider Demographics
NPI:1629781893
Name:KESHISHMOUSA, ELIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIN
Middle Name:
Last Name:KESHISHMOUSA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1428
Mailing Address - Country:US
Mailing Address - Phone:818-572-7883
Mailing Address - Fax:
Practice Address - Street 1:2811 N LIMA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-2511
Practice Address - Country:US
Practice Address - Phone:818-557-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist