=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619705571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMEMED PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2024
-----------------------------------------------------
Last Update Date | 07/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 839 W GLENOAKS BLVD
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91202-2133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-600-0777
-----------------------------------------------------
Fax | 818-649-1052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 839 W GLENOAKS BLVD
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91202-2133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-600-0777
-----------------------------------------------------
Fax | 818-649-1052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | ZAREH NAZARIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-600-0777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------