MEDICARE: SUPERIOR 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	PHY48287	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2111826	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437227675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR PHARMACY INC

Provider Business Mailing Address
First Line	:	11755 VICTORY BLVD
Second Line	:	STE 100A
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3423
Country	:	US
Telephone Number	:	818-980-9888
Fax Number	:	818-980-9881

Provider Business Practice Location Address
First Line	:	11755 VICTORY BLVD
Second Line	:	STE 100A
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3423
Country	:	US
Telephone Number	:	818-980-9888
Fax Number	:	818-980-9881

Authorized Official
Title or Position	:	SEC
Name	:	MARGARITA KHLGHATYAN
Credential	:
Telephone Number	:	818-640-3237

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	11/09/2015

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