Provider Demographics
NPI:1689209934
Name:MKRTCHIAN, NAIRI ANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NAIRI
Middle Name:ANNA
Last Name:MKRTCHIAN
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 1:2064 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1401
Mailing Address - Country:US
Mailing Address - Phone:818-640-6532
Mailing Address - Fax:
Practice Address - Street 1:15232 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2022
Practice Address - Country:US
Practice Address - Phone:818-374-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist