Provider Demographics
NPI:1487642757
Name:FHL PHARMACY, INC.
Entity Type:Organization
Organization Name:FHL PHARMACY, INC.
Other - Org Name:WESTERN RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARBEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHATOORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-314-8023
Mailing Address - Street 1:445 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204
Mailing Address - Country:US
Mailing Address - Phone:818-241-5996
Mailing Address - Fax:818-241-7149
Practice Address - Street 1:445 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204
Practice Address - Country:US
Practice Address - Phone:818-241-5996
Practice Address - Fax:818-241-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
CAPHY37971333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA379710Medicaid
CAPHA379710Medicaid