Provider Demographics
NPI:1871644856
Name:CENTRAL PHARMACY GROUP INC
Entity Type:Organization
Organization Name:CENTRAL PHARMACY GROUP INC
Other - Org Name:GLENDALE URGENT CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:626-429-4415
Mailing Address - Street 1:801 S CHEVY CHASE DR STE 111
Mailing Address - Street 2:STE 111
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4435
Mailing Address - Country:US
Mailing Address - Phone:818-502-9097
Mailing Address - Fax:818-502-9750
Practice Address - Street 1:801 S CHEVY CHASE DR STE 111
Practice Address - Street 2:STE 111
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4435
Practice Address - Country:US
Practice Address - Phone:818-502-9097
Practice Address - Fax:818-502-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116067OtherPK
CA1871644856Medicaid