Provider Demographics
NPI:1821091596
Name:EXPRESS CARE PHARMACY INC.
Entity Type:Organization
Organization Name:EXPRESS CARE PHARMACY INC.
Other - Org Name:EXPRESS CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKAYEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKAYELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-244-3330
Mailing Address - Street 1:801 E BROADWAY
Mailing Address - Street 2:UNIT A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4528
Mailing Address - Country:US
Mailing Address - Phone:818-244-3330
Mailing Address - Fax:818-244-5530
Practice Address - Street 1:801 E BROADWAY
Practice Address - Street 2:UNIT A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4528
Practice Address - Country:US
Practice Address - Phone:818-244-3330
Practice Address - Fax:818-244-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50437333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-75653OtherNABP NUMBER
CAPHY 50437OtherCALIFORNIA STATE BOARD OF PHARMACY RETAIL PERMIT
CA1821091596OtherMEDI-CAL PROVIDER NUMBER
CA1821091596OtherMEDI-CAL PROVIDER NUMBER