MEDICARE: MEDALLION PRESCRIPTION PHARMACY

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	PHY394090	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	:	1649267626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDALLION PRESCRIPTION PHARMACY

Provider Business Mailing Address
First Line	:	23101 SHERMAN PL
Second Line	:	SUITE #101
City	:	WEST HILLS
State	:	CA
Zip	:	91307-2008
Country	:	US
Telephone Number	:	818-789-6836
Fax Number	:	818-340-5075

Provider Business Practice Location Address
First Line	:	23101 SHERMAN PL
Second Line	:	SUITE #101
City	:	WEST HILLS
State	:	CA
Zip	:	91307-2008
Country	:	US
Telephone Number	:	818-789-6836
Fax Number	:	818-340-5075

Authorized Official
Title or Position	:	PHARMACIST
Name	:	DR. BEATRISA TSEYTLIN
Credential	:	PHARMD
Telephone Number	:	818-340-0212

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	08/22/2020

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Directions to “MEDALLION PRESCRIPTION PHARMACY ” Practice Location

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