Provider Demographics
NPI:1720775000
Name:PISIKYAN, ALISA
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:PISIKYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7806 TEESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2143
Mailing Address - Country:US
Mailing Address - Phone:818-255-6521
Mailing Address - Fax:
Practice Address - Street 1:12511 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-2305
Practice Address - Country:US
Practice Address - Phone:818-506-8795
Practice Address - Fax:818-506-8815
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89936183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty