Provider Demographics
NPI:1669779310
Name:LG PHARMACY INC.
Entity type:Organization
Organization Name:LG PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:323-664-6664
Mailing Address - Street 1:5400 HOLLYWOOD BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-3406
Mailing Address - Country:US
Mailing Address - Phone:323-664-6664
Mailing Address - Fax:866-247-6679
Practice Address - Street 1:5400 HOLLYWOOD BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-664-6664
Practice Address - Fax:866-247-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44799183500000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6684990001Medicare NSC