MEDICARE: KAY PHARMACY 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	3336C0003X	Community/Retail Pharmacy	51822	CA
2	333600000X	Pharmacy	51822	CA

General Provider Information

NPI Number	:	1316347735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAY PHARMACY INC

Provider Business Mailing Address
First Line	:	2313 W OLIVE AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 W OLIVE AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2627
Country	:	US
Telephone Number	:	818-270-0316
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. JOHN KHANBEKYAN
Credential	:
Telephone Number	:	818-270-0316

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	09/04/2014

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