Provider Demographics
NPI:1679850366
Name:TACHEJIAN, SEVAG (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SEVAG
Middle Name:
Last Name:TACHEJIAN
Suffix:
Gender:M
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 1:19614 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5720
Mailing Address - Country:US
Mailing Address - Phone:818-523-2377
Mailing Address - Fax:
Practice Address - Street 1:6700 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2624
Practice Address - Country:US
Practice Address - Phone:818-746-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist