Provider Demographics
NPI:1710589452
Name:TUFENKCHYAN, JACQUELINE ZHANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ZHANNA
Last Name:TUFENKCHYAN
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 1:11007 KLING ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1736
Mailing Address - Country:US
Mailing Address - Phone:818-720-6204
Mailing Address - Fax:818-766-9734
Practice Address - Street 1:2500 W VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1614
Practice Address - Country:US
Practice Address - Phone:818-955-8200
Practice Address - Fax:818-955-8985
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist