Provider Demographics
NPI:1396839676
Name:UMACO INC
Entity Type:Organization
Organization Name:UMACO INC
Other - Org Name:WILBUR MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHE
Authorized Official - Middle Name:G
Authorized Official - Last Name:APELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-342-0845
Mailing Address - Street 1:5620 WILBUR AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1351
Mailing Address - Country:US
Mailing Address - Phone:818-342-0845
Mailing Address - Fax:818-342-2599
Practice Address - Street 1:5620 WILBUR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:818-342-0845
Practice Address - Fax:818-342-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY34213333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ040034213OtherMEDCO HEALTH SOLNS
CA0592457OtherCA BLUE CROSS
CAPHA342130Medicaid
CAPHA342130Medicaid