Provider Demographics
NPI:1710108600
Name:ST JOSEPH PHARMACY INC
Entity Type:Organization
Organization Name:ST JOSEPH PHARMACY INC
Other - Org Name:ST JOSEPH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MINAS
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-736-5290
Mailing Address - Street 1:2519 W BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2302
Mailing Address - Country:US
Mailing Address - Phone:818-736-5290
Mailing Address - Fax:818-736-5276
Practice Address - Street 1:2519 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2302
Practice Address - Country:US
Practice Address - Phone:818-736-5290
Practice Address - Fax:818-736-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY519213336C0003X
CAPHY443233336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0519352OtherNCPDP
CAPHY51921OtherBOARD OF PHARMACY PERMIT
CAPHA443230Medicaid