Provider Demographics
NPI:1255155115
Name:HOLLYWOOD RX PHARMACY INC
Entity type:Organization
Organization Name:HOLLYWOOD RX PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARTASHES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-869-9997
Mailing Address - Street 1:2412 W MAGNOLIA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1738
Mailing Address - Country:US
Mailing Address - Phone:818-869-9997
Mailing Address - Fax:747-283-1265
Practice Address - Street 1:2412 W MAGNOLIA BLVD STE B
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1738
Practice Address - Country:US
Practice Address - Phone:818-869-9997
Practice Address - Fax:747-283-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY59554OtherBOARD OF PHARMACY