MEDICARE: SIPAN 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	PHY46718	CA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5613357	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841304839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIPAN PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 10128
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91209-3128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13635 VICTORY BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-1735
Country	:	US
Telephone Number	:	818-781-2006
Fax Number	:	818-781-2094

Authorized Official
Title or Position	:	OWNER
Name	:	ANNIE SARKISSIAN
Credential	:
Telephone Number	:	818-749-1231

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/11/2025

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Directions to “SIPAN PHARMACY INC ” Practice Location

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