=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427458033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORMANDY PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2014
-----------------------------------------------------
Last Update Date | 04/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12914-B SHERMAN WAY
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-358-4300
-----------------------------------------------------
Fax | 818-358-4399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12914-B SHERMAN WAY
-----------------------------------------------------
City | NORTH HOLLYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-358-4300
-----------------------------------------------------
Fax | 818-358-4399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PETROS NAZARIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-358-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 51977
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------