MEDICARE: GHST RX 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY59069	OTHER	CA	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1518552660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHST RX INC

Provider Business Mailing Address
First Line	:	16260 VENTURA BLVD STE 100
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-2207
Country	:	US
Telephone Number	:	818-386-1888
Fax Number	:	818-386-1188

Provider Business Practice Location Address
First Line	:	16260 VENTURA BLVD STE 100
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-2207
Country	:	US
Telephone Number	:	818-386-1888
Fax Number	:	818-386-1188

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	ALISA KAPUTIKYAN
Credential	:
Telephone Number	:	818-386-1888

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/27/2024

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Directions to “GHST RX INC ” Practice Location

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