Healthcare Provider Details

I. General information

NPI: 1982503397
Provider Name (Legal Business Name): EASYMED PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 FOOTHILL BLVD
LA CANADA CA
91011-2183
US

IV. Provider business mailing address

1367 FOOTHILL BLVD
LA CANADA CA
91011-2183
US

V. Phone/Fax

Practice location:
  • Phone: 818-766-5376
  • Fax: 818-766-9736
Mailing address:
  • Phone: 818-766-5376
  • Fax: 818-766-9736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MIKIA AIVAZE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 818-766-5376