Provider Demographics
NPI:1912010604
Name:KOVACS PHARMACY INC
Entity Type:Organization
Organization Name:KOVACS PHARMACY INC
Other - Org Name:KOVAC'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSTILNIKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-786-2660
Mailing Address - Street 1:14423 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1430
Mailing Address - Country:US
Mailing Address - Phone:818-786-2660
Mailing Address - Fax:818-782-3100
Practice Address - Street 1:14423 GILMORE ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1430
Practice Address - Country:US
Practice Address - Phone:818-786-2660
Practice Address - Fax:818-782-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY499683336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0502408OtherNCPDP PROVIDER IDENTIFICATION NUMBER