Provider Demographics
NPI:1154541043
Name:THOMASSIAN, KRISTAPOR VAHAN (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTAPOR
Middle Name:VAHAN
Last Name:THOMASSIAN
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 1:45 OLD CHICO WAY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7901
Mailing Address - Country:US
Mailing Address - Phone:530-343-0480
Mailing Address - Fax:
Practice Address - Street 1:45 OLD CHICO WAY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7901
Practice Address - Country:US
Practice Address - Phone:530-343-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488201835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy