Healthcare Provider Details

I. General information

NPI: 1306277298
Provider Name (Legal Business Name): DR. IKE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11738 VENTURA BLVD.
STUDIO CITY CA
91604
US

IV. Provider business mailing address

11736 VENTURA BLVD
STUDIO CITY CA
91604-2615
US

V. Phone/Fax

Practice location:
  • Phone: 818-432-2484
  • Fax: 818-432-2488
Mailing address:
  • Phone: 818-432-2484
  • Fax: 818-432-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51681
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AYK DZHRAGATSPANYAN
Title or Position: PRESIDENT/PIC
Credential:
Phone: 818-432-2484