Healthcare Provider Details

I. General information

NPI: 1518072537
Provider Name (Legal Business Name): GLENDALE WEST DRUG COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 S GLENDALE AVE # AB
GLENDALE CA
91205-5657
US

IV. Provider business mailing address

1109 S GLENDALE AVE # AB
GLENDALE CA
91205-5657
US

V. Phone/Fax

Practice location:
  • Phone: 818-548-5157
  • Fax: 818-548-1064
Mailing address:
  • Phone: 818-548-5157
  • Fax: 818-548-1064

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 NumberPHY43706
License Number StateCA

VIII. Authorized Official

Name: MALIKSET ALADADI
Title or Position: OFFICER,AO
Credential:
Phone: 818-548-5157