Provider Demographics
NPI:1427610633
Name:RX BOUTIQUE PHARMACY INC
Entity type:Organization
Organization Name:RX BOUTIQUE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC,COO
Authorized Official - Prefix:
Authorized Official - First Name:EDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KYURKCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-514-6010
Mailing Address - Street 1:18425 BURBANK BLVD STE 414
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2810
Mailing Address - Country:US
Mailing Address - Phone:818-514-6010
Mailing Address - Fax:818-514-6140
Practice Address - Street 1:18425 BURBANK BLVD STE 414
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2810
Practice Address - Country:US
Practice Address - Phone:818-514-6010
Practice Address - Fax:818-514-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427610633Medicaid