Provider Demographics
NPI:1073084539
Name:HOVHANESSIAN, JACQUELINE (PHARMD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HOVHANESSIAN
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 1:5200 WHITE OAK AVE UNIT 52
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4518
Mailing Address - Country:US
Mailing Address - Phone:818-512-6388
Mailing Address - Fax:
Practice Address - Street 1:6500 WILSHIRE BLVD STE 2240
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4935
Practice Address - Country:US
Practice Address - Phone:310-385-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty