Provider Demographics
NPI:1952763765
Name:ABAZYAN, IRINA
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:ABAZYAN
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 1:6920 MARSUE DR APT T1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1237
Mailing Address - Country:US
Mailing Address - Phone:410-600-5830
Mailing Address - Fax:
Practice Address - Street 1:6104 OLD SILVER HILL RD
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2111
Practice Address - Country:US
Practice Address - Phone:240-788-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist