Provider Demographics
NPI:1912526872
Name:MINASYAN, AKOP (PHARMD)
Entity Type:Individual
Prefix:
First Name:AKOP
Middle Name:
Last Name:MINASYAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2829
Mailing Address - Country:US
Mailing Address - Phone:818-845-8313
Mailing Address - Fax:818-845-8300
Practice Address - Street 1:2200 N GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-2829
Practice Address - Country:US
Practice Address - Phone:818-845-8313
Practice Address - Fax:818-845-8300
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA65434OtherLICENSE