Provider Demographics
NPI:1689456816
Name:STEPANYAN, LUSINE
Entity type:Individual
Prefix:
First Name:LUSINE
Middle Name:
Last Name:STEPANYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 N 93RD AVE APT 2067
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3192
Mailing Address - Country:US
Mailing Address - Phone:818-414-6340
Mailing Address - Fax:
Practice Address - Street 1:1855 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-6308
Practice Address - Country:US
Practice Address - Phone:602-439-6862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist