Provider Demographics
NPI:1295053031
Name:ARIYAN CORPORATION
Entity type:Organization
Organization Name:ARIYAN CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUMANTA
Authorized Official - Middle Name:BARAN
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-771-9988
Mailing Address - Street 1:600 MORRO BAY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1935
Mailing Address - Country:US
Mailing Address - Phone:805-771-9988
Mailing Address - Fax:805-771-9960
Practice Address - Street 1:600 MORRO BAY BLVD STE B
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1965
Practice Address - Country:US
Practice Address - Phone:805-771-9988
Practice Address - Fax:805-771-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336C0003X
CA502273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295053031Medicaid
2124902OtherPK
CA1295053031Medicaid
5637838OtherNCPDP PROVIDER IDENTIFICATION NUMBER