Provider Demographics
NPI:1982754727
Name:SUNSET CENTER PHARMACY,INC
Entity Type:Organization
Organization Name:SUNSET CENTER PHARMACY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARDIROS
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTEGUIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-664-1882
Mailing Address - Street 1:5137 1/2 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5715
Mailing Address - Country:US
Mailing Address - Phone:323-664-1882
Mailing Address - Fax:323-664-1809
Practice Address - Street 1:5137 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5715
Practice Address - Country:US
Practice Address - Phone:323-664-1882
Practice Address - Fax:323-664-1809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA448750Medicaid
CA4147810001Medicare ID - Type Unspecified