Healthcare Provider Details

I. General information

NPI: 1629224381
Provider Name (Legal Business Name): ABC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16311 VENTURA BLVD STE 110
ENCINO CA
91436-2124
US

IV. Provider business mailing address

16311 VENTURA BLVD STE 110
ENCINO CA
91436-2124
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-0422
  • Fax: 818-783-0423
Mailing address:
  • Phone: 818-783-0422
  • Fax: 818-783-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY49183
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARKAIDY KHAMIOV
Title or Position: PIC
Credential:
Phone: 323-363-7250