Healthcare Provider Details

I. General information

NPI: 1619369527
Provider Name (Legal Business Name): PHARMACIST HOLDING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9528 TOPANGA CYN BLVD
CHATSWORTH CA
91311
US

IV. Provider business mailing address

9528 TOPANGA CYN BLVD
CHATSWORTH CA
91311
US

V. Phone/Fax

Practice location:
  • Phone: 818-960-4664
  • Fax: 818-960-4660
Mailing address:
  • Phone: 818-960-4664
  • Fax: 818-960-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number55421
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY55421
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number55421
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY55421
License Number StateCA

VIII. Authorized Official

Name: MR. KEVORK SHAHE SHAHINIAN
Title or Position: CEO/OWNER
Credential: PHARM.D.
Phone: 818-960-4664