Provider Demographics
NPI:1881989077
Name:DERZAKHARIAN, MELINA
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:DERZAKHARIAN
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 1:1800 W EMPIRE AVE
Mailing Address - Street 2:T-1362 TARGET PHARMACY
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504
Mailing Address - Country:US
Mailing Address - Phone:818-238-0239
Mailing Address - Fax:818-238-0239
Practice Address - Street 1:1800 W EMPIRE AVE
Practice Address - Street 2:T-1362 TARGET PHARMACY
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504
Practice Address - Country:US
Practice Address - Phone:818-238-0239
Practice Address - Fax:818-238-0239
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist