Provider Demographics
NPI:1790090280
Name:AVS PHARMACY INC
Entity Type:Organization
Organization Name:AVS PHARMACY INC
Other - Org Name:AVS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VARDUI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALUMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-484-8680
Mailing Address - Street 1:511 1/2 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1110
Mailing Address - Country:US
Mailing Address - Phone:818-484-8680
Mailing Address - Fax:818-484-8684
Practice Address - Street 1:511 1/2 E BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1110
Practice Address - Country:US
Practice Address - Phone:818-484-8680
Practice Address - Fax:818-484-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50366333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 50366OtherRETAIL PHARMACY PERMIT