Provider Demographics
NPI:1821517301
Name:HAROUTUNIAN, TINA MARION (PHARMD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARION
Last Name:HAROUTUNIAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10430 WILSHIRE BLVD APT 1104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4654
Mailing Address - Country:US
Mailing Address - Phone:801-548-7053
Mailing Address - Fax:
Practice Address - Street 1:8000 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2439
Practice Address - Country:US
Practice Address - Phone:323-656-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist