Provider Demographics
NPI:1043570385
Name:GBV CORPORATION
Entity Type:Organization
Organization Name:GBV CORPORATION
Other - Org Name:ARCADE LANE COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:GAYANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BESNELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-577-7979
Mailing Address - Street 1:700 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2102
Mailing Address - Country:US
Mailing Address - Phone:626-577-7979
Mailing Address - Fax:626-577-7977
Practice Address - Street 1:700 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2102
Practice Address - Country:US
Practice Address - Phone:626-577-7979
Practice Address - Fax:626-577-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509303336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5644009OtherNCPDP PROVIDER IDENTIFICATION NUMBER