Provider Demographics
NPI:1861265522
Name:MEKHITARIAN, LISA TAMAR (PHARMD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:TAMAR
Last Name:MEKHITARIAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 CORO TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2509
Mailing Address - Country:US
Mailing Address - Phone:818-438-8442
Mailing Address - Fax:
Practice Address - Street 1:4900 RIVERGRADE RD
Practice Address - Street 2:
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-1401
Practice Address - Country:US
Practice Address - Phone:626-939-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist