Provider Demographics
NPI:1427130202
Name:PHARMACY CENTRAL
Entity type:Organization
Organization Name:PHARMACY CENTRAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ZHOZEF
Authorized Official - Middle Name:
Authorized Official - Last Name:GADIMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-731-1515
Mailing Address - Street 1:3009 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3033
Mailing Address - Country:US
Mailing Address - Phone:323-731-1515
Mailing Address - Fax:323-731-1919
Practice Address - Street 1:3009 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3033
Practice Address - Country:US
Practice Address - Phone:323-731-1515
Practice Address - Fax:323-731-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY475213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5614208OtherNCPDP PROVIDER IDENTIFICATION NUMBER