Provider Demographics
NPI:1518552660
Name:GHST RX INC
Entity Type:Organization
Organization Name:GHST RX INC
Other - Org Name:CENTRAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPUTIKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-386-1888
Mailing Address - Street 1:16260 VENTURA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2207
Mailing Address - Country:US
Mailing Address - Phone:818-386-1888
Mailing Address - Fax:818-386-1188
Practice Address - Street 1:16260 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2207
Practice Address - Country:US
Practice Address - Phone:818-386-1888
Practice Address - Fax:818-386-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY59069OtherBOARD OF PHARMACY