Provider Demographics
NPI:1073676730
Name:ARDEN DRUGS INC
Entity Type:Organization
Organization Name:ARDEN DRUGS INC
Other - Org Name:ARDEN MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:KAMBIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FARZAMDOOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-247-1842
Mailing Address - Street 1:435 ARDEN AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1130
Mailing Address - Country:US
Mailing Address - Phone:818-247-1842
Mailing Address - Fax:818-247-9059
Practice Address - Street 1:435 ARDEN AVE
Practice Address - Street 2:STE 110
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1130
Practice Address - Country:US
Practice Address - Phone:818-247-1842
Practice Address - Fax:818-247-9059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY536363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154688OtherPK
CAPHA53636Medicaid
7497450001Medicare NSC
4809030001Medicare ID - Type Unspecified