=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265953764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MED-CENTURY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8660 WOODLEY AVE STE 101
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91343-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-529-2777
-----------------------------------------------------
Fax | 818-529-6276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8660 WOODLEY AVE STE 101
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91343-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-529-2777
-----------------------------------------------------
Fax | 818-529-6276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. KAREN HOVHANNISYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-829-6277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 55668
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------