Provider Demographics
NPI:1609964949
Name:MASK, INC.
Entity Type:Organization
Organization Name:MASK, INC.
Other - Org Name:SYLMAR PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM. D./ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUSUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:IWANAGA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-362-6894
Mailing Address - Street 1:12737 GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4704
Mailing Address - Country:US
Mailing Address - Phone:818-362-6894
Mailing Address - Fax:818-362-6896
Practice Address - Street 1:12737 GLENOAKS BLVD STE 27
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4777
Practice Address - Country:US
Practice Address - Phone:818-362-6894
Practice Address - Fax:818-362-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY436273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1355431Medicaid
CA1355431Medicaid