Provider Demographics
NPI:1659527224
Name:CARRIES PHARMACY INC
Entity Type:Organization
Organization Name:CARRIES PHARMACY INC
Other - Org Name:CARRIE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIRANUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRGATBASHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-543-0240
Mailing Address - Street 1:501 N GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1123
Mailing Address - Country:US
Mailing Address - Phone:818-567-1114
Mailing Address - Fax:818-567-1115
Practice Address - Street 1:501 N GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1123
Practice Address - Country:US
Practice Address - Phone:818-567-1114
Practice Address - Fax:818-567-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50474333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY50474OtherCALIFORNIA STATE BOARD OF PHARMACY RETAIL PERMIT
CA1659527224Medicaid
5631418OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5631418OtherNCPDP PROVIDER IDENTIFICATION NUMBER