Healthcare Provider Details

I. General information

NPI: 1710992367
Provider Name (Legal Business Name): MIRACLE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19225 VENTURA BLVD
TARZANA CA
91356-3122
US

IV. Provider business mailing address

19225 VENTURA BLVD
TARZANA CA
91356-3122
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-2878
  • Fax: 818-996-2877
Mailing address:
  • Phone: 818-996-2878
  • Fax: 818-996-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY51652
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51652
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY51652
License Number StateCA

VIII. Authorized Official

Name: ARTHUR KARAGEZYAN
Title or Position: OWNER
Credential:
Phone: 818-996-2878