Provider Demographics
NPI:1710663299
Name:KIRAKOSSIAN, MKRTICH MICHAEL (RPH)
Entity Type:Individual
Prefix:DR
First Name:MKRTICH
Middle Name:MICHAEL
Last Name:KIRAKOSSIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:KIRAKOSSIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:151 N SWALL DR APT 2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1913
Mailing Address - Country:US
Mailing Address - Phone:949-275-4743
Mailing Address - Fax:
Practice Address - Street 1:11177 TAMPA AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2254
Practice Address - Country:US
Practice Address - Phone:818-350-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH81599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist