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General NPI Number Information
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NPI Number | 1336150960
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Entity Type | Organization
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Legal Business Name | WESTSIDE BOUTIQUE PHARMACY INC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 7643 N SAN FERNANDO RD
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City | BURBANK
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State | CA
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Zip | 91505-1073
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Country | US
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Telephone | 818-504-6444
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Fax | 818-504-6441
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Provider Business Mailing Address
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Address Line | PO BOX 5063
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City | GLENDALE
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State | CA
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Zip | 91221-1063
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | SEVAK OLMESSEKIAN
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Credential |
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Telephone | 323-533-5516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY45059
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License Number State | CA
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