Provider Demographics
NPI:1972053445
Name:KIRAKOSYAN, KARMEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KARMEN
Middle Name:
Last Name:KIRAKOSYAN
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 1:101 N VERDUGO RD
Mailing Address - Street 2:PO BOX #11364
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91226-7801
Mailing Address - Country:US
Mailing Address - Phone:310-479-5729
Mailing Address - Fax:
Practice Address - Street 1:1433 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2428
Practice Address - Country:US
Practice Address - Phone:310-479-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-09
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist