Healthcare Provider Details

I. General information

NPI: 1265011027
Provider Name (Legal Business Name): MIX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 BALBOA BLVD STE 211
ENCINO CA
91316-1517
US

IV. Provider business mailing address

6345 BALBOA BLVD STE 211
ENCINO CA
91316-1517
US

V. Phone/Fax

Practice location:
  • Phone: 818-798-3833
  • Fax: 818-302-2500
Mailing address:
  • Phone: 818-798-3833
  • Fax: 818-302-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AKOP MARTIKYAN
Title or Position: CEO/SEC/CFO/DIR/PRESIDENT
Credential:
Phone: 818-798-3833