Provider Demographics
NPI:1386871457
Name:GHARIBIAN, DERENIK (PHARMD)
Entity type:Individual
Prefix:
First Name:DERENIK
Middle Name:
Last Name:GHARIBIAN
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 1:1515 N VERMONT AVE
Mailing Address - Street 2:# 237
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5337
Mailing Address - Country:US
Mailing Address - Phone:323-783-8306
Mailing Address - Fax:
Practice Address - Street 1:1515 N VERMONT AVE
Practice Address - Street 2:# 237
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5337
Practice Address - Country:US
Practice Address - Phone:323-783-8306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist