Provider Demographics
NPI:1487716064
Name:REMEDY DRUGS BROADWAY INC
Entity type:Organization
Organization Name:REMEDY DRUGS BROADWAY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DERHARTOUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-548-6165
Mailing Address - Street 1:459 W BROADWAY
Mailing Address - Street 2:STE 4
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4120
Mailing Address - Country:US
Mailing Address - Phone:818-548-6165
Mailing Address - Fax:818-548-7095
Practice Address - Street 1:459 W BROADWAY
Practice Address - Street 2:STE 4
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4120
Practice Address - Country:US
Practice Address - Phone:818-548-6165
Practice Address - Fax:818-548-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY536533336C0003X
CA510803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY53653OtherBOARD OF PHARMACY PERMIT
CA05-68420OtherNCPDP PROVIDER
2137536OtherPK
CA1487716064Medicaid