Provider Demographics
NPI:1043202146
Name:BEVERLY PLAZA RX INC
Entity Type:Organization
Organization Name:BEVERLY PLAZA RX INC
Other - Org Name:BEVERLY PLAZA RX INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/CFO/SECRETARY/DIRECTO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-725-7155
Mailing Address - Street 1:101 E BEVERLY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4314
Mailing Address - Country:US
Mailing Address - Phone:323-725-7155
Mailing Address - Fax:323-725-7766
Practice Address - Street 1:101 E BEVERLY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4314
Practice Address - Country:US
Practice Address - Phone:323-725-7155
Practice Address - Fax:323-725-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0508335OtherNCPDP
BB3531630OtherDEA
5587740001Medicare NSC