Healthcare Provider Details

I. General information

NPI: 1386994655
Provider Name (Legal Business Name): KOVAC'S CARE RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14423 GILMORE ST
VAN NUYS CA
91401
US

IV. Provider business mailing address

14423 GILMORE ST
VAN NUYS CA
91401
US

V. Phone/Fax

Practice location:
  • Phone: 818-786-2669
  • Fax: 818-786-3100
Mailing address:
  • Phone: 818-786-2669
  • Fax: 818-782-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ARSEN NAZARYAN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 818-786-2669