Provider Demographics
NPI:1942300983
Name:GAA PHARMACY INC
Entity Type:Organization
Organization Name:GAA PHARMACY INC
Other - Org Name:HAIG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-414-2622
Mailing Address - Street 1:1112 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3203
Mailing Address - Country:US
Mailing Address - Phone:818-500-0800
Mailing Address - Fax:818-500-8527
Practice Address - Street 1:1112 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3203
Practice Address - Country:US
Practice Address - Phone:818-500-0800
Practice Address - Fax:818-500-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0004X
CAPHY518503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146884OtherPK
2146884OtherPK
CAPHA376170Medicaid
4548670001Medicare NSC