Provider Demographics
NPI:1558358465
Name:SIRMID, INC
Entity Type:Organization
Organization Name:SIRMID, INC
Other - Org Name:KEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIRANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDURYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-509-3630
Mailing Address - Street 1:12660 RIVERSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3429
Mailing Address - Country:US
Mailing Address - Phone:818-509-3630
Mailing Address - Fax:818-509-3628
Practice Address - Street 1:12660 RIVERSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3429
Practice Address - Country:US
Practice Address - Phone:818-509-3630
Practice Address - Fax:818-509-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA441540Medicaid
CAPHY44154OtherPHARMACY LICENSE