Provider Demographics
NPI:1306551353
Name:GALOIAN, HAGOP JACK (PHARMD)
Entity type:Individual
Prefix:
First Name:HAGOP
Middle Name:JACK
Last Name:GALOIAN
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 1:11913 DARBY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1322
Mailing Address - Country:US
Mailing Address - Phone:323-898-8515
Mailing Address - Fax:
Practice Address - Street 1:11975 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2541
Practice Address - Country:US
Practice Address - Phone:866-701-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist