Provider Demographics
NPI:1689224545
Name:CANYON RX INC
Entity Type:Organization
Organization Name:CANYON RX INC
Other - Org Name:101 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASTOURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-395-5509
Mailing Address - Street 1:12117 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:818-927-4249
Mailing Address - Fax:818-927-4215
Practice Address - Street 1:12117 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607
Practice Address - Country:US
Practice Address - Phone:818-927-4249
Practice Address - Fax:818-927-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy