Provider Demographics
NPI:1265011027
Name:MIX PHARMACY INC
Entity Type:Organization
Organization Name:MIX PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SEC/CFO/DIR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKOP
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-798-3833
Mailing Address - Street 1:6345 BALBOA BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1517
Mailing Address - Country:US
Mailing Address - Phone:818-798-3833
Mailing Address - Fax:818-302-2500
Practice Address - Street 1:6345 BALBOA BLVD STE 211
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1517
Practice Address - Country:US
Practice Address - Phone:818-798-3833
Practice Address - Fax:818-302-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy