Provider Demographics
NPI:1306335104
Name:KHATCHATURIAN, ELIZABETH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:KHATCHATURIAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 VERDUGO BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1449
Mailing Address - Country:US
Mailing Address - Phone:818-952-2223
Mailing Address - Fax:
Practice Address - Street 1:1808 VERDUGO BLVD STE 111
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1449
Practice Address - Country:US
Practice Address - Phone:818-952-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty