Provider Demographics
NPI:1831736065
Name:SUPER PILL INC
Entity type:Organization
Organization Name:SUPER PILL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-800-2265
Mailing Address - Street 1:6320 VAN NUYS BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6637
Mailing Address - Country:US
Mailing Address - Phone:310-800-2265
Mailing Address - Fax:310-861-5898
Practice Address - Street 1:6320 VAN NUYS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6637
Practice Address - Country:US
Practice Address - Phone:310-800-2265
Practice Address - Fax:310-861-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57174OtherBOARD OF PHARMACY PERMIT