Healthcare Provider Details

I. General information

NPI: 1871693804
Provider Name (Legal Business Name): CENTRAL DRUGS & MEDICAL SUPPLY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 SOUTH CENTRAL AVENUE STE 110
GLENDALE CA
91204
US

IV. Provider business mailing address

1510 SOUTH CENTRAL AVENUE STE 110
GLENDALE CA
91204
US

V. Phone/Fax

Practice location:
  • Phone: 818-247-0526
  • Fax: 818-247-3076
Mailing address:
  • Phone: 818-247-0526
  • Fax: 818-247-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY35919
License Number StateCA

VIII. Authorized Official

Name: ZOHRAB KHACHERYAN
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 323-333-4074