Provider Demographics
NPI:1962959718
Name:BOSTANIAN, ROBERT LEVON (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEVON
Last Name:BOSTANIAN
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 1:3520 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3415
Mailing Address - Country:US
Mailing Address - Phone:504-466-6848
Mailing Address - Fax:504-888-9410
Practice Address - Street 1:3520 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3415
Practice Address - Country:US
Practice Address - Phone:504-466-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist