MEDICARE: PW PLAZA RX 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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY58363	OTHER	CA	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1912449380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PW PLAZA RX INC

Provider Business Mailing Address
First Line	:	7230 MEDICAL CENTER DR STE 106
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4003
Country	:	US
Telephone Number	:	818-346-6550
Fax Number	:	818-348-4663

Provider Business Practice Location Address
First Line	:	7230 MEDICAL CENTER DR STE 106
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4003
Country	:	US
Telephone Number	:	818-346-6550
Fax Number	:	818-348-4663

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	AIDA GEVORGYAN
Credential	:
Telephone Number	:	818-346-6550

Provider Enumeration Date	:	11/16/2016
Last Update Date	:	06/16/2022

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Directions to “PW PLAZA RX INC ” Practice Location

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