Provider Demographics
NPI:1972814796
Name:KESHISHIAN, SUSANNA (PHARM D)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:KESHISHIAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3397 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1717
Mailing Address - Country:US
Mailing Address - Phone:818-429-4470
Mailing Address - Fax:
Practice Address - Street 1:821 AMERICANA WAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91210-1509
Practice Address - Country:US
Practice Address - Phone:818-243-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 54817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist