MEDICARE: SDA INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	44225	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2065158	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235140815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SDA INC

Provider Business Mailing Address
First Line	:	5181 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5715
Country	:	US
Telephone Number	:	323-666-7778
Fax Number	:	323-666-7588

Provider Business Practice Location Address
First Line	:	5181 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5715
Country	:	US
Telephone Number	:	323-666-7778
Fax Number	:	323-666-7588

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SARMEN OVSEPIAN
Credential	:
Telephone Number	:	323-666-7778

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	06/13/2013

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Directions to “SDA INC ” Practice Location

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