MEDICARE: SIRMID, 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

General Provider Information

NPI Number	:	1558358465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIRMID, INC

Provider Business Mailing Address
First Line	:	12660 RIVERSIDE DR
Second Line	:	SUITE 100
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3429
Country	:	US
Telephone Number	:	818-509-3630
Fax Number	:	818-509-3628

Provider Business Practice Location Address
First Line	:	12660 RIVERSIDE DR
Second Line	:	SUITE 100
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3429
Country	:	US
Telephone Number	:	818-509-3630
Fax Number	:	818-509-3628

Authorized Official
Title or Position	:	OWNER
Name	:	SIRANUSH MIDURYAN
Credential	:
Telephone Number	:	818-509-3630

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	12/22/2023

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