Provider Demographics
NPI:1407921232
Name:SOCIK DIKRAN
Entity Type:Organization
Organization Name:SOCIK DIKRAN
Other - Org Name:DRUG CENTER PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOCIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIKRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-507-8466
Mailing Address - Street 1:1530 E CHEVY CHASE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4163
Mailing Address - Country:US
Mailing Address - Phone:818-507-8466
Mailing Address - Fax:818-507-0241
Practice Address - Street 1:1530 E CHEVY CHASE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4163
Practice Address - Country:US
Practice Address - Phone:818-507-8466
Practice Address - Fax:818-507-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY451363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA451360Medicaid
1992314OtherPK