Healthcare Provider Details

I. General information

NPI: 1457775736
Provider Name (Legal Business Name): UNICARE PHARMACY & SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE STE 104
PASADENA CA
91105-2561
US

IV. Provider business mailing address

301 S FAIR OAKS AVE STE 104
PASADENA CA
91105-2561
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7771
  • Fax: 626-793-7772
Mailing address:
  • Phone: 626-793-7771
  • Fax: 626-793-7772

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51250
License Number StateCA

VIII. Authorized Official

Name: LILI GEVORKIAN
Title or Position: CEO
Credential: RPH
Phone: 626-793-7771