1922511351 NPI number — BLISS PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922511351 NPI number — BLISS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLISS 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:
Provider Other Organization Name Type Code:
6
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:
1922511351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22998 VENTURA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91364-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-912-6104
Provider Business Mailing Address Fax Number:
818-912-6410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22998 VENTURA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODLAND HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91364-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-912-6104
Provider Business Practice Location Address Fax Number:
818-912-6410
Provider Enumeration Date:
11/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KLNDJUYAN
Authorized Official First Name:
SMBAT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-912-6104

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  55729 , 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: PHY55729 . This is a "BOARD OF PHARMACY PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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