Healthcare Provider Details

I. General information

NPI: 1316562077
Provider Name (Legal Business Name): MAGGIE'S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 KUEHNER DR STE 107
SIMI VALLEY CA
93063-3960
US

IV. Provider business mailing address

2315 KUEHNER DR STE 107
SIMI VALLEY CA
93063-3960
US

V. Phone/Fax

Practice location:
  • Phone: 805-770-1001
  • Fax: 805-770-1002
Mailing address:
  • Phone: 805-770-1001
  • Fax: 805-770-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NARE PETOYAN
Title or Position: PRESIDENT/PIC
Credential: PHARM D
Phone: 805-770-1001