Provider Demographics
NPI:1659771558
Name:ANTOSSIAN, TAMAR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAMAR
Middle Name:
Last Name:ANTOSSIAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19003 VINCENNES ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2823
Mailing Address - Country:US
Mailing Address - Phone:818-719-8610
Mailing Address - Fax:
Practice Address - Street 1:6433 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3543
Practice Address - Country:US
Practice Address - Phone:818-719-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist