Provider Demographics
NPI:1750676037
Name:ERNA INC
Entity Type:Organization
Organization Name:ERNA INC
Other - Org Name:SAN JUDAS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDZHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-389-5858
Mailing Address - Street 1:2201 W PICO BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4837
Mailing Address - Country:US
Mailing Address - Phone:213-389-5858
Mailing Address - Fax:213-389-5800
Practice Address - Street 1:2201 W PICO BLVD STE G
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4837
Practice Address - Country:US
Practice Address - Phone:213-389-5858
Practice Address - Fax:213-389-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5642500OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5642500OtherNCPDP PROVIDER IDENTIFICATION NUMBER