Provider Demographics
NPI:1760192488
Name:MARTIROSYAN, ANI
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:MARTIROSYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 GARFIELD PL APT 214
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-4005
Mailing Address - Country:US
Mailing Address - Phone:323-497-2226
Mailing Address - Fax:
Practice Address - Street 1:3943 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2721
Practice Address - Country:US
Practice Address - Phone:818-549-2270
Practice Address - Fax:818-549-2273
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist