Provider Demographics
NPI:1851100747
Name:KHANZETYAN, LILY (RPH)
Entity type:Individual
Prefix:DR
First Name:LILY
Middle Name:
Last Name:KHANZETYAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 HAZELTINE AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-5353
Mailing Address - Country:US
Mailing Address - Phone:818-644-2880
Mailing Address - Fax:
Practice Address - Street 1:6606 HAZELTINE AVE APT 101
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-5353
Practice Address - Country:US
Practice Address - Phone:818-644-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist