Provider Demographics
NPI:1295052249
Name:ARIANNA MEDICAL PHARMACY INC
Entity type:Organization
Organization Name:ARIANNA MEDICAL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEFYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-404-7358
Mailing Address - Street 1:3600 N VERDUGO RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1219
Mailing Address - Country:US
Mailing Address - Phone:818-957-9200
Mailing Address - Fax:818-957-9201
Practice Address - Street 1:3600 N VERDUGO RD STE 103
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1258
Practice Address - Country:US
Practice Address - Phone:818-957-9200
Practice Address - Fax:818-957-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY503353336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295052249Medicaid
2126051OtherPK
2126051OtherPK