Provider Demographics
NPI:1689943623
Name:BASMADJIAN, SOUREN (RPH)
Entity Type:Individual
Prefix:DR
First Name:SOUREN
Middle Name:
Last Name:BASMADJIAN
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 1:2840 W AVENUE L
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4006
Mailing Address - Country:US
Mailing Address - Phone:661-943-8683
Mailing Address - Fax:
Practice Address - Street 1:2840 W AVENUE L
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4006
Practice Address - Country:US
Practice Address - Phone:661-943-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist