Healthcare Provider Details

I. General information

NPI: 1992882286
Provider Name (Legal Business Name): GOODFELLOW PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12157 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3204
US

IV. Provider business mailing address

12157 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3204
US

V. Phone/Fax

Practice location:
  • Phone: 818-754-0949
  • Fax: 818-754-0944
Mailing address:
  • Phone: 818-754-0949
  • Fax: 818-754-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MKRTICH DISHIGRIKIAN
Title or Position: CPA
Credential:
Phone: 818-754-0949