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General NPI Number Information
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NPI Number | 1114303872
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Entity Type | Organization
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Legal Business Name | M A N NAZARETH INC
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 350 S GLENOAKS BLVD
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City | BURBANK
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State | CA
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Zip | 91502-1318
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Country | US
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Telephone | 818-848-0220
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Fax | 818-848-0221
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Provider Business Mailing Address
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Address Line | 350 S GLENOAKS BLVD
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City | BURBANK
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State | CA
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Zip | 91502-1318
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Country | US
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Telephone | 818-848-0220
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Fax | 818-848-0221
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL NAZARIAN
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Credential |
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Telephone | 818-848-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 53607
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License Number State | CA
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