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Organization
WESTSIDE BOUTIQUE PHARMACY INC
Active
Organization
WESTSIDE BOUTIQUE PHARMACY INC
Active
Other names
WESTSIDE BOUTIQUE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
SEVAK OLMESSEKIAN (PHARMACIST IN CHARGE)
(323) 533-5516
Entity
Organization
Contact information
Practice address
7643 N SAN FERNANDO RD, BURBANK, CA 91505-1073
(818) 504-6444
(818) 504-6441
Mailing address
PO BOX 5063, GLENDALE, CA 91221-1063
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY45059
CA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0559522
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA450590
—
CA
Enumeration date
08/10/2006
Last updated
06/19/2009
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