Provider Demographics
NPI:1609247469
Name:AAA CARE RX INC
Entity Type:Organization
Organization Name:AAA CARE RX INC
Other - Org Name:AAA CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:AYVAZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-914-4194
Mailing Address - Street 1:6729 VARIEL AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2811
Mailing Address - Country:US
Mailing Address - Phone:818-914-4194
Mailing Address - Fax:818-914-4596
Practice Address - Street 1:6729 VARIEL AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2811
Practice Address - Country:US
Practice Address - Phone:818-914-4194
Practice Address - Fax:818-914-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 53748OtherBOARD OF PHARMACY