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General NPI Number Information
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NPI Number | 1609415934
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Entity Type | Organization
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Legal Business Name | IVY PHARMACY
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 315 W VERDUGO AVE STE A
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City | BURBANK
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State | CA
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Zip | 91502-2469
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Country | US
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Telephone | 423-747-8118
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Fax | 424-303-7854
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Provider Business Mailing Address
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Address Line | 315 W VERDUGO AVE STE A
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City | BURBANK
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State | CA
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Zip | 91502-2469
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Country | US
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Telephone | 423-747-8118
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Fax | 424-303-7854
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. ALI BAGHERI
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Credential |
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Telephone | 423-747-8118
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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 |
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License Number State |
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