Provider Demographics
NPI:1528298064
Name:IM PHARMACY INC
Entity type:Organization
Organization Name:IM PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-335-4000
Mailing Address - Street 1:10970 SHERMAN WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1002
Mailing Address - Country:US
Mailing Address - Phone:818-847-8600
Mailing Address - Fax:818-847-8698
Practice Address - Street 1:10970 SHERMAN WAY STE 110
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1003
Practice Address - Country:US
Practice Address - Phone:818-847-8600
Practice Address - Fax:818-847-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY51128333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51128OtherRETAIL PHARMACY PERMIT
5635012OtherNCPDP PROVIDER IDENTIFICATION NUMBER