Provider Demographics
NPI:1881468833
Name:GUKASYAN, MARIA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:GUKASYAN
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 1:3415 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1155
Mailing Address - Country:US
Mailing Address - Phone:818-476-8310
Mailing Address - Fax:
Practice Address - Street 1:4744 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1833
Practice Address - Country:US
Practice Address - Phone:818-505-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist