Provider Demographics
NPI:1134371230
Name:SUPERIOR PHARMACY INC
Entity type:Organization
Organization Name:SUPERIOR PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHLGHATYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-691-3351
Mailing Address - Street 1:11755 VICTORY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3448
Mailing Address - Country:US
Mailing Address - Phone:818-691-3351
Mailing Address - Fax:818-691-3371
Practice Address - Street 1:11755 VICTORY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3448
Practice Address - Country:US
Practice Address - Phone:818-691-3351
Practice Address - Fax:818-691-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY492153336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117716OtherPK