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General NPI Number Information
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NPI Number | 1578908778
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Entity Type | Organization
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Legal Business Name | SUPER PHARM INC
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 15714 1/2 VANOWEN ST
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City | VAN NUYS
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State | CA
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Zip | 91406-5029
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Country | US
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Telephone | 818-386-8555
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Fax | 818-387-6210
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Provider Business Mailing Address
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Address Line | 15714 1/2 VANOWEN ST
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City | VAN NUYS
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State | CA
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Zip | 91406-5029
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Country | US
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Telephone | 818-386-8555
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Fax | 818-387-6210
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. LUIZA MALOYAN
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Credential |
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Telephone | 818-386-8555
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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 | PHY55554
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License Number State | CA
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