MEDICARE: SUPREME CARE 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	PHY 53878	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY53878	OTHER	CA	CALLFORNIA STATE BOARD OF PHARMACY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	56-58096	OTHER	CA	NCPDP PROVIDER

General Provider Information

NPI Number	:	1417322736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPREME CARE PHARMACY, INC.

Provider Business Mailing Address
First Line	:	6007 LANKERSHIM BLVD
Second Line	:	#7
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4883
Country	:	US
Telephone Number	:	818-763-7007
Fax Number	:	818-763-7006

Provider Business Practice Location Address
First Line	:	6007 LANKERSHIM BLVD
Second Line	:	#7
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4883
Country	:	US
Telephone Number	:	818-763-7007
Fax Number	:	818-763-7006

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. GEVORG GRIGORYAN
Credential	:
Telephone Number	:	818-763-7007

Provider Enumeration Date	:	12/11/2015
Last Update Date	:	11/04/2025

Similar Medicare Providers

1215152988 — DR. TALIA AMIR DDS
Practice Location Address:

6007 LANKERSHIM BLVD STE 9
NORTH HOLLYWOOD, CA
91606-4883

Practice Phone: 818-506-2977
Practice Fax: 818-506-4610

1285854018 — DR AMIR AND DR HAMER DENTAL
Practice Location Address:

6007 LANKERSHIM BLVD STE 9
NORTH HOLLYWOOD, CA
91606-4883

Practice Phone: 818-506-2977
Practice Fax: 818-506-4610

1518104678 — DR. ANNIE AGHAJANIAN-ABOULIAN DMD
Practice Location Address:

6007 LANKERSHIM BLVD STE 9
NORTH HOLLYWOOD, CA
91606-4883

Practice Phone: 818-505-8083
Practice Fax:

1730586108 — ANNIE ABOULIAN A DENTAL CORPORATION
Practice Location Address:

6007 LANKERSHIM BLVD STE 9
NORTH HOLLYWOOD, CA
91606-4883

Practice Phone: 818-505-8083
Practice Fax:

1548610256 — AAA INTERCONNECT CARE INC.
Practice Location Address:

6007 LANKERSHIM BLVD
NORTH HOLLYWOOD, CA
91606-4883

Practice Phone: 818-754-1221
Practice Fax: 818-754-1205

1164942769 — SIAMAK TEHRANI
Practice Location Address:

6007 LANKERSHIM BLVD STE 7
NORTH HOLLYWOOD, CA
91606-4883

Practice Phone: 818-763-7007
Practice Fax:

Directions to “SUPREME CARE PHARMACY, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.