Provider Demographics
NPI:1235140815
Name:SDA INC
Entity Type:Organization
Organization Name:SDA INC
Other - Org Name:UNIVERSAL DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OVSEPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-666-7778
Mailing Address - Street 1:5181 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5715
Mailing Address - Country:US
Mailing Address - Phone:323-666-7778
Mailing Address - Fax:323-666-7588
Practice Address - Street 1:5181 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5715
Practice Address - Country:US
Practice Address - Phone:323-666-7778
Practice Address - Fax:323-666-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA442253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065158OtherPK
CAPHA442250Medicaid
1295500001Medicare NSC