Healthcare Provider Details

I. General information

NPI: 1598816571
Provider Name (Legal Business Name): THREE WISE MEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W. GLENOAKS BLVD. UNIT E
GLENDALE CA
91201
US

IV. Provider business mailing address

1700 W. GLENOAKS BLVD. UNIT E
GLENDALE CA
91201
US

V. Phone/Fax

Practice location:
  • Phone: 818-549-1010
  • Fax: 818-549-0505
Mailing address:
  • Phone: 818-549-1010
  • Fax: 818-549-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY42129
License Number StateCA

VIII. Authorized Official

Name: ANDRANIK HARUTYUNYAN
Title or Position: CEO/DIR.
Credential:
Phone: 818-489-3653