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General NPI Number Information
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NPI Number | 1376084202
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Entity Type | Organization
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Legal Business Name | GOLDEN STATE SPECIALTY PHARMACY
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Dates
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Enumeration Date | 03/11/2017
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Last Update Date | 03/11/2017
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Provider Practice Location Address
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Address Line | 325 N VICTORY BLVD
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City | BURBANK
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State | CA
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Zip | 91502-1841
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Country | US
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Telephone | 888-658-0801
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Fax |
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Provider Business Mailing Address
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Address Line | 325 N VICTORY BLVD
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City | BURBANK
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State | CA
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Zip | 91502-1841
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Country | US
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Telephone | 888-658-0801
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ARMEN APOYAN
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Credential |
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Telephone | 888-658-0801
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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 | PHY54580
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY54580
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | PHY54580
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY54580
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License Number State | CA
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