Healthcare Provider Details

I. General information

NPI: 1578837118
Provider Name (Legal Business Name): SAYBIAN ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22030 SHERMAN WAY STE 100
CANOGA PARK CA
91303-1855
US

IV. Provider business mailing address

22030 SHERMAN WAY STE 100
CANOGA PARK CA
91303-1855
US

V. Phone/Fax

Practice location:
  • Phone: 818-883-9490
  • Fax: 818-883-9493
Mailing address:
  • Phone: 818-883-9490
  • Fax: 818-883-9493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY 49208
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 49208
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY 49208
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID SUTTON
Title or Position: CFO
Credential:
Phone: 818-883-9490