Provider Demographics
NPI:1497742399
Name:NORMANDY PHARMACY INC
Entity Type:Organization
Organization Name:NORMANDY PHARMACY INC
Other - Org Name:NORMANDY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETROS
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-913-3337
Mailing Address - Street 1:5112 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6124
Mailing Address - Country:US
Mailing Address - Phone:323-913-3337
Mailing Address - Fax:323-913-0318
Practice Address - Street 1:5112 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6124
Practice Address - Country:US
Practice Address - Phone:323-913-3337
Practice Address - Fax:323-913-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY43795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA437950Medicaid
CAPHA437950Medicaid