Provider Demographics
NPI:1922356120
Name:MARKET PHARMACY LLC
Entity Type:Organization
Organization Name:MARKET PHARMACY LLC
Other - Org Name:MARKET PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TATEVOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-349-9795
Mailing Address - Street 1:9250 RESEDA BLVD
Mailing Address - Street 2:UNIT 2D
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3142
Mailing Address - Country:US
Mailing Address - Phone:818-349-9795
Mailing Address - Fax:818-349-9918
Practice Address - Street 1:9250 RESEDA BLVD
Practice Address - Street 2:UNIT 2D
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3142
Practice Address - Country:US
Practice Address - Phone:818-349-9795
Practice Address - Fax:818-349-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4592590002Medicare NSC