Provider Demographics
NPI:1003331612
Name:BOULEVARD PHARMACY INC
Entity Type:Organization
Organization Name:BOULEVARD PHARMACY INC
Other - Org Name:TREATMEDNGO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASMADJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-482-6793
Mailing Address - Street 1:8950 W OLYMPIC BLVD STE 103&104
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8950 W OLYMPIC BLVD STE 103&104
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3561
Practice Address - Country:US
Practice Address - Phone:310-274-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center