Healthcare Provider Details

I. General information

NPI: 1619703881
Provider Name (Legal Business Name): NORMANDY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5112 HOLLYWOOD BLVD STE 104
LOS ANGELES CA
90027-6124
US

IV. Provider business mailing address

5112 HOLLYWOOD BLVD STE 104
LOS ANGELES CA
90027-6124
US

V. Phone/Fax

Practice location:
  • Phone: 323-913-3337
  • Fax: 323-913-0318
Mailing address:
  • Phone: 323-913-3337
  • Fax: 323-913-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETROS NAZARIAN
Title or Position: CEO
Credential:
Phone: 323-913-3337