Provider Demographics
NPI:1790090116
Name:GINOSYAN, LILI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LILI
Middle Name:
Last Name:GINOSYAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 WHISPERING PINES CT
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4459
Mailing Address - Country:US
Mailing Address - Phone:818-609-9021
Mailing Address - Fax:
Practice Address - Street 1:17864 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3615
Practice Address - Country:US
Practice Address - Phone:818-345-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532571835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy