Healthcare Provider Details

I. General information

NPI: 1033190376
Provider Name (Legal Business Name): COLORADO PHARMACY AND SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 COLORADO BLVD
LOS ANGELES CA
90041-1436
US

IV. Provider business mailing address

1680 COLORADO BLVD
LOS ANGELES CA
90041-1436
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-6736
  • Fax: 323-254-8772
Mailing address:
  • Phone: 323-254-6736
  • Fax: 323-254-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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: ASYA SIMONYAN
Title or Position: OWNER
Credential:
Phone: 323-254-6736