Healthcare Provider Details

I. General information

NPI: 1063407252
Provider Name (Legal Business Name): SORTPAK RX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 N CENTRAL AVE FL 22
GLENDALE CA
91203-1444
US

IV. Provider business mailing address

655 N CENTRAL AVE FL 22
GLENDALE CA
91203-1444
US

V. Phone/Fax

Practice location:
  • Phone: 877-570-7787
  • Fax: 877-475-2382
Mailing address:
  • Phone: 877-570-7787
  • Fax: 877-475-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND SHIRVANYAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 877-570-7787