Provider Demographics
NPI:1790986610
Name:MINASYAN, SHOGHIK SHINE
Entity Type:Individual
Prefix:
First Name:SHOGHIK
Middle Name:SHINE
Last Name:MINASYAN
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 1:232 N CEDAR ST APT 7
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4470
Mailing Address - Country:US
Mailing Address - Phone:818-624-7877
Mailing Address - Fax:
Practice Address - Street 1:232 N CEDAR ST APT 7
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4470
Practice Address - Country:US
Practice Address - Phone:818-624-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43267183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician