Provider Demographics
NPI:1649587742
Name:METHORDA LTD
Entity Type:Organization
Organization Name:METHORDA LTD
Other - Org Name:TRICARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HRATCHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDAKJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-985-5005
Mailing Address - Street 1:13237 SATICOY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-3435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13237 SATICOY ST STE 4
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3435
Practice Address - Country:US
Practice Address - Phone:818-317-6785
Practice Address - Fax:818-985-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA466160Medicaid