Provider Demographics
NPI:1639389570
Name:GHOUGASSIAN, RAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:GHOUGASSIAN
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 1:3332 CAMINO VALLAREAL
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-7456
Mailing Address - Country:US
Mailing Address - Phone:760-480-6953
Mailing Address - Fax:
Practice Address - Street 1:3332 CAMINO VALLAREAL
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-7456
Practice Address - Country:US
Practice Address - Phone:760-480-6953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist