Provider Demographics
NPI:1720550858
Name:K & S EAGLESTEIN INC
Entity Type:Organization
Organization Name:K & S EAGLESTEIN INC
Other - Org Name:SYLMAR MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEVAK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVAGIMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-640-9515
Mailing Address - Street 1:13677 FOOTHILL BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-698-4053
Mailing Address - Fax:818-698-4046
Practice Address - Street 1:13677 FOOTHILL BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-698-4053
Practice Address - Fax:818-698-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56853OtherCALIFORNIA STATE BOARD OF PHARMACY