Provider Demographics
NPI:1346261393
Name:BURBANK COMPOUNDING PHARMACY INC
Entity Type:Organization
Organization Name:BURBANK COMPOUNDING PHARMACY INC
Other - Org Name:BURBANK COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TATEVOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-563-2120
Mailing Address - Street 1:201 S BUENA VISTA ST
Mailing Address - Street 2:STE 110
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4569
Mailing Address - Country:US
Mailing Address - Phone:818-563-2120
Mailing Address - Fax:818-563-2130
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:STE 110
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-563-2120
Practice Address - Fax:818-563-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY488733336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2112936OtherPK
6036760001Medicare NSC