Provider Demographics
NPI:1235168501
Name:BEN FRIEDMAN, INC
Entity Type:Organization
Organization Name:BEN FRIEDMAN, INC
Other - Org Name:BOULEVARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-262-6222
Mailing Address - Street 1:10771 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-5155
Mailing Address - Country:US
Mailing Address - Phone:818-503-8806
Mailing Address - Fax:818-503-8826
Practice Address - Street 1:10771 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-5155
Practice Address - Country:US
Practice Address - Phone:818-503-8806
Practice Address - Fax:818-503-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY448393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA448390Medicaid
CA0572974OtherNABP #
CAAB9764095OtherDEA
CAPHA448390Medicaid