Provider Demographics
NPI:1609938331
Name:ATHENA PHARMACY INC
Entity Type:Organization
Organization Name:ATHENA PHARMACY INC
Other - Org Name:986 PHARMACY #8015
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-337-1510
Mailing Address - Street 1:14332 RAMONA BLVD.
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3241
Mailing Address - Country:US
Mailing Address - Phone:626-337-1510
Mailing Address - Fax:626-337-1540
Practice Address - Street 1:14332 RAMONA BLVD.
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3241
Practice Address - Country:US
Practice Address - Phone:626-337-1510
Practice Address - Fax:626-337-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59003OtherCA BOP
CA0261450001Medicare NSC