Provider Demographics
NPI:1437227675
Name:SUPERIOR PHARMACY INC
Entity Type:Organization
Organization Name:SUPERIOR PHARMACY INC
Other - Org Name:SUPERIOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHLGHATYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-640-3237
Mailing Address - Street 1:11755 VICTORY BLVD
Mailing Address - Street 2:STE 100A
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3423
Mailing Address - Country:US
Mailing Address - Phone:818-980-9888
Mailing Address - Fax:818-980-9881
Practice Address - Street 1:11755 VICTORY BLVD
Practice Address - Street 2:STE 100A
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3423
Practice Address - Country:US
Practice Address - Phone:818-980-9888
Practice Address - Fax:818-980-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY482873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2111826OtherPK
CA5656140Medicaid