Provider Demographics
NPI:1124682802
Name:KHACHERYAN, ZOHRAB
Entity type:Individual
Prefix:
First Name:ZOHRAB
Middle Name:
Last Name:KHACHERYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 VERDUGO BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1626
Mailing Address - Country:US
Mailing Address - Phone:818-248-8018
Mailing Address - Fax:
Practice Address - Street 1:2037 VERDUGO BLVD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1626
Practice Address - Country:US
Practice Address - Phone:323-333-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist