Healthcare Provider Details

I. General information

NPI: 1902891773
Provider Name (Legal Business Name): ASTRAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6368 HOLLYWOOD BLVD
LOS ANGELES CA
90028-6320
US

IV. Provider business mailing address

PO BOX 4070
BURBANK CA
91503-4070
US

V. Phone/Fax

Practice location:
  • Phone: 323-466-9931
  • Fax: 323-466-9932
Mailing address:
  • Phone: 323-466-9931
  • Fax: 323-466-9932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY42171
License Number StateCA

VIII. Authorized Official

Name: GAYANE KIRAKOSYAN
Title or Position: PRESIDENT
Credential: PH.D
Phone: 323-466-9931