MEDICARE: COLORADO PHARMACY AND SUPPLY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PHY60520	OTHER	CA	PHARMACY PERMIT

General Provider Information

NPI Number	:	1033190376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO PHARMACY AND SUPPLY INC

Provider Business Mailing Address
First Line	:	1680 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1436
Country	:	US
Telephone Number	:	323-254-6736
Fax Number	:	323-254-8772

Provider Business Practice Location Address
First Line	:	1680 COLORADO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1436
Country	:	US
Telephone Number	:	323-254-6736
Fax Number	:	323-254-8772

Authorized Official
Title or Position	:	OWNER
Name	:	ASYA SIMONYAN
Credential	:
Telephone Number	:	323-254-6736

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	03/24/2025

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Directions to “COLORADO PHARMACY AND SUPPLY INC ” Practice Location

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