Provider Demographics
NPI:1649767641
Name:KAGOYAN, HARUTYUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:HARUTYUN
Middle Name:
Last Name:KAGOYAN
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 1:14147 GAULT ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3261
Mailing Address - Country:US
Mailing Address - Phone:818-648-4427
Mailing Address - Fax:
Practice Address - Street 1:7640 TAMPA AVE STE E
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1700
Practice Address - Country:US
Practice Address - Phone:818-578-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist