Provider Demographics
NPI:1215427653
Name:AVETISYAN-ANDRANIKYAN, ALLA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:AVETISYAN-ANDRANIKYAN
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 1:7124 COLDWATER CYN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-7300
Mailing Address - Country:US
Mailing Address - Phone:818-497-2047
Mailing Address - Fax:
Practice Address - Street 1:7124 COLDWATER CANYON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-7300
Practice Address - Country:US
Practice Address - Phone:818-764-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist