Provider Demographics
NPI:1730064882
Name:VAHRATYAN, SERGEY NERSESI (PHARMD)
Entity type:Individual
Prefix:
First Name:SERGEY
Middle Name:NERSESI
Last Name:VAHRATYAN
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 1:435 E VALENCIA AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-2789
Mailing Address - Country:US
Mailing Address - Phone:818-433-8904
Mailing Address - Fax:
Practice Address - Street 1:435 E VALENCIA AVE APT 202
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-2789
Practice Address - Country:US
Practice Address - Phone:818-433-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22732-40183500000X
CA91015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist