Healthcare Provider Details

I. General information

NPI: 1346261393
Provider Name (Legal Business Name): BURBANK COMPOUNDING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST STE 110
BURBANK CA
91505-4569
US

IV. Provider business mailing address

201 S BUENA VISTA ST STE 110
BURBANK CA
91505-4569
US

V. Phone/Fax

Practice location:
  • Phone: 818-563-2120
  • Fax: 818-563-2130
Mailing address:
  • Phone: 818-563-2120
  • Fax: 818-563-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48873
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARMEN TATEVOSSIAN
Title or Position: PRESIDENT
Credential: PHARM.D
Phone: 818-563-2120