Provider Demographics
NPI:1467808683
Name:SUNLAND PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:SUNLAND PHARMACY INCORPORATED
Other - Org Name:SUNLAND PHARMACY INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO/PIC
Authorized Official - Prefix:
Authorized Official - First Name:LUSINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-962-3851
Mailing Address - Street 1:8422 SUNLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3436
Mailing Address - Country:US
Mailing Address - Phone:818-962-3851
Mailing Address - Fax:818-962-3850
Practice Address - Street 1:8422 SUNLAND BLVD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-3436
Practice Address - Country:US
Practice Address - Phone:818-962-3851
Practice Address - Fax:818-962-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY543453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160401OtherPK
CA1467808683Medicaid