Provider Demographics
NPI:1487721478
Name:MEGUERDITCHIAN, SAMUEL O (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:O
Last Name:MEGUERDITCHIAN
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 1:4700 W SUNSET BLVD
Mailing Address - Street 2:2ND FLOOR SUITE # 2087
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6082
Mailing Address - Country:US
Mailing Address - Phone:323-783-1078
Mailing Address - Fax:323-783-7360
Practice Address - Street 1:4700 W SUNSET BLVD
Practice Address - Street 2:2ND FLOOR ROOM # 2087
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6082
Practice Address - Country:US
Practice Address - Phone:323-783-1078
Practice Address - Fax:323-783-7360
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist