MEDICARE: HYE 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	PHY39986	CA

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	:	1568455780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYE PHARMACY INC

Provider Business Mailing Address
First Line	:	5236 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1210
Country	:	US
Telephone Number	:	323-661-7152
Fax Number	:	323-661-7269

Provider Business Practice Location Address
First Line	:	13745 VICTORY BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2348
Country	:	US
Telephone Number	:	818-782-7152
Fax Number	:	818-782-1354

Authorized Official
Title or Position	:	PRESIDENT/PHARMACIST
Name	:	MR. PETROS TAGLYAN
Credential	:	PHARMD
Telephone Number	:	323-661-7152

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/03/2022

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