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General NPI Number Information
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NPI Number | 1215132105
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Entity Type | Organization
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Legal Business Name | N E A CORPORATION
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 800 S CENTRAL AVE STE A
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City | GLENDALE
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State | CA
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Zip | 91204-4370
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Country | US
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Telephone | 323-722-0778
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Fax | 323-278-1121
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Provider Business Mailing Address
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Address Line | 5207 HOLLYWOOD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-4908
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Country | US
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Telephone | 323-461-9451
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | VARTAN GEVORKIAN
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Credential |
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Telephone | 323-722-0778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50049
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License Number State | CA
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