Provider Demographics
NPI:1891120275
Name:TASHYAN, AVETIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:AVETIS
Middle Name:
Last Name:TASHYAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 WENDOVER RD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-4131
Mailing Address - Country:US
Mailing Address - Phone:818-517-0493
Mailing Address - Fax:
Practice Address - Street 1:728 WENDOVER RD
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-4131
Practice Address - Country:US
Practice Address - Phone:818-517-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist