Provider Demographics
NPI:1770309429
Name:HAMBARDZUMYAN, ANI
Entity type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:HAMBARDZUMYAN
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 1:7220 WOODMAN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2665
Mailing Address - Country:US
Mailing Address - Phone:818-809-2525
Mailing Address - Fax:818-809-2526
Practice Address - Street 1:8019 IRVINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1606
Practice Address - Country:US
Practice Address - Phone:323-354-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist