Provider Demographics
NPI:1750379152
Name:AVAKIAN, INC.
Entity type:Organization
Organization Name:AVAKIAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:AVAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-888-7455
Mailing Address - Street 1:22110 ROSCOE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3845
Mailing Address - Country:US
Mailing Address - Phone:818-888-7455
Mailing Address - Fax:818-888-1032
Practice Address - Street 1:22110 ROSCOE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-3845
Practice Address - Country:US
Practice Address - Phone:818-888-7455
Practice Address - Fax:818-888-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0573748OtherNABP
CAPHA451550Medicaid
CAPHA451550Medicaid