Provider Demographics
NPI:1457802423
Name:GHAZARYAN, NAIRA
Entity Type:Individual
Prefix:
First Name:NAIRA
Middle Name:
Last Name:GHAZARYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S ADAMS ST APT 12
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5215
Mailing Address - Country:US
Mailing Address - Phone:818-303-5015
Mailing Address - Fax:
Practice Address - Street 1:1100 W ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5108
Practice Address - Country:US
Practice Address - Phone:310-884-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist