Provider Demographics
NPI:1609415934
Name:IVY PHARMACY
Entity Type:Organization
Organization Name:IVY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-747-8118
Mailing Address - Street 1:315 W VERDUGO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2469
Mailing Address - Country:US
Mailing Address - Phone:423-747-8118
Mailing Address - Fax:424-303-7854
Practice Address - Street 1:315 W VERDUGO AVE STE A
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2469
Practice Address - Country:US
Practice Address - Phone:423-747-8118
Practice Address - Fax:424-303-7854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy