Provider Demographics
NPI:1548678683
Name:KHACHATRYAN, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KHACHATRYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 W BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2507
Mailing Address - Country:US
Mailing Address - Phone:602-246-6601
Mailing Address - Fax:602-246-3908
Practice Address - Street 1:1607 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2507
Practice Address - Country:US
Practice Address - Phone:602-246-6601
Practice Address - Fax:602-246-3908
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist