MEDICARE: ASTRAL 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY42171	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0572140	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902891773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTRAL PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 4070
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91503-4070
Country	:	US
Telephone Number	:	323-466-9931
Fax Number	:	323-466-9932

Provider Business Practice Location Address
First Line	:	6368 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6320
Country	:	US
Telephone Number	:	323-466-9931
Fax Number	:	323-466-9932

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GAYANE KIRAKOSYAN
Credential	:	PH.D
Telephone Number	:	323-466-9931

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	09/06/2012

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Directions to “ASTRAL PHARMACY INC ” Practice Location

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