Healthcare Provider Details

I. General information

NPI: 1306771860
Provider Name (Legal Business Name): FORTIVA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19562 VENTURA BLVD STE 226
TARZANA CA
91356-6065
US

IV. Provider business mailing address

19562 VENTURA BLVD STE 226
TARZANA CA
91356-6065
US

V. Phone/Fax

Practice location:
  • Phone: 818-757-8977
  • Fax:
Mailing address:
  • Phone: 818-757-8977
  • Fax:

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: MAGDY ZOUEN
Title or Position: OWNER
Credential:
Phone: 818-757-8977