Provider Demographics
NPI:1154027357
Name:AVETISYAN, ARTHUR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:AVETISYAN
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 1:834 GRAYNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2608
Mailing Address - Country:US
Mailing Address - Phone:818-808-6855
Mailing Address - Fax:
Practice Address - Street 1:3604 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2917
Practice Address - Country:US
Practice Address - Phone:818-956-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty