MEDICARE: PRIMA 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	PHY51571	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
2	PHY 51571	OTHER	CA	STATE BOARD OF PHARMACY LICENSE

General Provider Information

NPI Number	:	1730529959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMA PHARMACY INC

Provider Business Mailing Address
First Line	:	12643 SHERMAN WAY STE C
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-5271
Country	:	US
Telephone Number	:	818-765-2555
Fax Number	:	818-765-2755

Provider Business Practice Location Address
First Line	:	12643 SHERMAN WAY
Second Line	:	UNIT C
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-5270
Country	:	US
Telephone Number	:	818-765-2555
Fax Number	:	818-765-2755

Authorized Official
Title or Position	:	OWNER
Name	:	NOUNE GASPARYAN
Credential	:
Telephone Number	:	818-765-2555

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	12/24/2025

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Directions to “PRIMA PHARMACY INC ” Practice Location

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