Provider Demographics
NPI:1508171786
Name:GOLDEN CARE PHARMACY INC
Entity Type:Organization
Organization Name:GOLDEN CARE PHARMACY INC
Other - Org Name:GOLDEN CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACY TECHNICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOROZANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY TECHNICIAN
Authorized Official - Phone:323-234-9956
Mailing Address - Street 1:4128 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-2221
Mailing Address - Country:US
Mailing Address - Phone:323-234-9956
Mailing Address - Fax:323-234-0060
Practice Address - Street 1:4128 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2221
Practice Address - Country:US
Practice Address - Phone:323-234-9956
Practice Address - Fax:323-234-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 503793336C0003X
CAPHY 5037983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6505420001Medicare NSC
CA6505420001Medicare NSC