Provider Demographics
NPI:1073682928
Name:BERJ TERZIAN
Entity Type:Organization
Organization Name:BERJ TERZIAN
Other - Org Name:ALVARADO DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:TERZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-388-9518
Mailing Address - Street 1:819 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4018
Mailing Address - Country:US
Mailing Address - Phone:213-388-9518
Mailing Address - Fax:213-388-8212
Practice Address - Street 1:819 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4018
Practice Address - Country:US
Practice Address - Phone:213-388-9518
Practice Address - Fax:213-388-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY332493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA332490Medicaid
2051721OtherPK