MEDICARE: RX BOUTIQUE PHARMACY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	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

General Provider Information

NPI Number	:	1427610633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RX BOUTIQUE PHARMACY INC

Provider Business Mailing Address
First Line	:	18425 BURBANK BLVD STE 414
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-2810
Country	:	US
Telephone Number	:	818-514-6010
Fax Number	:	818-514-6140

Provider Business Practice Location Address
First Line	:	18425 BURBANK BLVD STE 414
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-2810
Country	:	US
Telephone Number	:	818-514-6010
Fax Number	:	818-514-6140

Authorized Official
Title or Position	:	CEO
Name	:	ARMEN MARTIROSYAN
Credential	:
Telephone Number	:	818-514-6010

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	06/01/2026

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