Healthcare Provider Details

I. General information

NPI: 1376768168
Provider Name (Legal Business Name): GLENDALE MEDICAL ARTS CENTER PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 GRIFFITH PARK BLVD
LOS ANGELES CA
90027-3343
US

IV. Provider business mailing address

2716 GRIFFITH PARK BLVD
LOS ANGELES CA
90027-3343
US

V. Phone/Fax

Practice location:
  • Phone: 323-661-8366
  • Fax: 323-661-0538
Mailing address:
  • Phone: 323-661-8366
  • Fax: 323-661-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY381860
License Number StateCA

VIII. Authorized Official

Name: DR. SORIN KAZANGIAN
Title or Position: OWNER PHARMACIST
Credential:
Phone: 323-661-8366