Provider Demographics
NPI:1932411840
Name:ANDONIAN, GILBERT SEBOUH (RPH)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:SEBOUH
Last Name:ANDONIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:GILBERT
Other - Middle Name:SEBOUH
Other - Last Name:ANDONIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:17420 FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2210
Mailing Address - Country:US
Mailing Address - Phone:818-523-3348
Mailing Address - Fax:
Practice Address - Street 1:17420 FLANDERS ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-2210
Practice Address - Country:US
Practice Address - Phone:818-523-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAITIN183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist