Provider Demographics
NPI:1487454039
Name:ROSCOE PHARMACY RX INC
Entity type:Organization
Organization Name:ROSCOE PHARMACY RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NASTARAN
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:KOHANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-578-0111
Mailing Address - Street 1:18539 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4632
Mailing Address - Country:US
Mailing Address - Phone:818-578-0111
Mailing Address - Fax:818-578-0222
Practice Address - Street 1:18539 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4632
Practice Address - Country:US
Practice Address - Phone:818-578-0111
Practice Address - Fax:818-578-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY60588OtherBOARDOF PHARMACY