MEDICARE: EXPRESS CARE PHARMACY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHY50437	CA
2	3336C0003X	Community/Retail Pharmacy	PHY50437	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05-75653	OTHER	CA	NABP NUMBER
2	PHY 50437	OTHER	CA	CALIFORNIA STATE BOARD OF PHARMACY RETAIL PERMIT
3	1821091596	OTHER	CA	MEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1821091596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS CARE PHARMACY INC.

Provider Business Mailing Address
First Line	:	801 E BROADWAY
Second Line	:	UNIT A
City	:	GLENDALE
State	:	CA
Zip	:	91205-4528
Country	:	US
Telephone Number	:	818-244-3330
Fax Number	:	818-244-5530

Provider Business Practice Location Address
First Line	:	801 E BROADWAY
Second Line	:	UNIT A
City	:	GLENDALE
State	:	CA
Zip	:	91205-4528
Country	:	US
Telephone Number	:	818-244-3330
Fax Number	:	818-244-5530

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MIKAYEL MIKAYELYAN
Credential	:
Telephone Number	:	818-244-3330

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/07/2023

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Directions to “EXPRESS CARE PHARMACY INC. ” Practice Location

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