Provider Demographics
NPI:1336130186
Name:NOBLE PHARMACY INC
Entity Type:Organization
Organization Name:NOBLE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDROSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-321-0177
Mailing Address - Street 1:321 E ALAMEDA BLVD
Mailing Address - Street 2:SUITE L
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-3328
Mailing Address - Country:US
Mailing Address - Phone:818-563-6655
Mailing Address - Fax:818-563-6611
Practice Address - Street 1:321 E ALAMEDA BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-3328
Practice Address - Country:US
Practice Address - Phone:818-563-6655
Practice Address - Fax:818-563-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY 44636333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336130186Medicaid