Provider Demographics
NPI:1255051314
Name:ODABASHYAN, SONA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SONA
Middle Name:
Last Name:ODABASHYAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:SONA
Other - Middle Name:
Other - Last Name:SOURENIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 S EVERETT ST APT 5
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1102
Mailing Address - Country:US
Mailing Address - Phone:323-821-5406
Mailing Address - Fax:
Practice Address - Street 1:445 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1208
Practice Address - Country:US
Practice Address - Phone:818-241-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH84131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist