1508953845 NPI number — NOUBARS EL ADOBE PHARMACY INC

Table of content: (NPI 1508953845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508953845 NPI number — NOUBARS EL ADOBE PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOUBARS EL ADOBE PHARMACY 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:
NOUBAR'S EL ADOBE PHARMACY INC.
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:
1508953845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5207 HOLLYWOOD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90027-4998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-461-9451
Provider Business Mailing Address Fax Number:
323-461-7134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5207 HOLLYWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-461-9451
Provider Business Practice Location Address Fax Number:
323-461-7134
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GEVORKIAN
Authorized Official First Name:
VARTAN
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
323-461-9454

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 51195 , 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: 2138891 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1508953845 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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