Provider Demographics
NPI:1710432992
Name:ENFIEDJIAN, SANDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ENFIEDJIAN
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 1:4904 W SUNSET BLVD
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5814
Mailing Address - Country:US
Mailing Address - Phone:323-783-7613
Mailing Address - Fax:323-783-6909
Practice Address - Street 1:4904 W SUNSET BLVD
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5814
Practice Address - Country:US
Practice Address - Phone:323-783-7613
Practice Address - Fax:323-786-6909
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist