Provider Demographics
NPI:1568455780
Name:HYE PHARMACY INC
Entity Type:Organization
Organization Name:HYE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PETROS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGLYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:323-661-7152
Mailing Address - Street 1:5236 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1210
Mailing Address - Country:US
Mailing Address - Phone:323-661-7152
Mailing Address - Fax:323-661-7269
Practice Address - Street 1:13745 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2348
Practice Address - Country:US
Practice Address - Phone:818-782-7152
Practice Address - Fax:818-782-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY39986333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA399860Medicaid
CAPHA399860Medicaid