1164506283 NPI number — CALIFORNIA DRUGS, INC

Table of content: (NPI 1164506283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164506283 NPI number — CALIFORNIA DRUGS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA DRUGS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTRAL DRUGS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164506283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 S CENTRAL AVE
Provider Second Line Business Mailing Address:
STE 117
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91204-2061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-956-1577
Provider Business Mailing Address Fax Number:
818-244-5308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
STE 117
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91204-2061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-956-1577
Provider Business Practice Location Address Fax Number:
818-244-5308
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DERMENJIAN
Authorized Official First Name:
MIHRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
818-956-1577

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY42184 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2065172 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: PHA421840 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".