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General NPI Number Information
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NPI Number | 1508971367
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Entity Type | Organization
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Legal Business Name | OPTIMA CARE PHARMACY , INC.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 1755 W GLENOAKS BLVD UNIT E
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City | GLENDALE
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State | CA
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Zip | 91201-4363
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Country | US
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Telephone | 818-548-5488
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Fax | 818-548-4709
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Provider Business Mailing Address
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Address Line | 1755 W GLENOAKS BLVD UNIT E
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City | GLENDALE
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State | CA
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Zip | 91201-4363
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Country | US
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Telephone | 818-548-5488
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Fax | 818-548-4709
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. SEPUH T. ISAGHULIAN
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Credential | PHARM.D.
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Telephone | 818-548-5488
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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 | PHY47047
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License Number State | CA
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