Provider Demographics
NPI:1750048104
Name:AGAZARYAN, LUSIK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LUSIK
Middle Name:
Last Name:AGAZARYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:AGAZARYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:315 W ALAMEDA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-3355
Mailing Address - Country:US
Mailing Address - Phone:818-823-7799
Mailing Address - Fax:
Practice Address - Street 1:12746 W JEFFERSON BLVD STE 3160
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2778
Practice Address - Country:US
Practice Address - Phone:310-862-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist