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General NPI Number Information
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NPI Number | 1265011027
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Entity Type | Organization
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Legal Business Name | MIX PHARMACY INC
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 6345 BALBOA BLVD STE 211
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City | ENCINO
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State | CA
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Zip | 91316-1517
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Country | US
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Telephone | 818-798-3833
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Fax | 818-302-2500
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Provider Business Mailing Address
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Address Line | 6345 BALBOA BLVD STE 211
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City | ENCINO
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State | CA
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Zip | 91316-1517
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Country | US
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Telephone | 818-798-3833
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Fax | 818-302-2500
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Authorized Official
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Title or Position | CEO/SEC/CFO/DIR/PRESIDENT
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Name | AKOP MARTIKYAN
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Credential |
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Telephone | 818-798-3833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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