Provider Demographics
NPI:1245921915
Name:NERSESIAN, TEREZA ELEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TEREZA
Middle Name:ELEN
Last Name:NERSESIAN
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 1:3008 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3720
Mailing Address - Country:US
Mailing Address - Phone:818-406-6080
Mailing Address - Fax:
Practice Address - Street 1:11273 LAUREL CANYON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4359
Practice Address - Country:US
Practice Address - Phone:818-638-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist