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Organization
MMG TEAM INC
Active
Organization
MMG TEAM INC
Active
Other names
WESTCOAST SPECIALTY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARINE MANANYAN GYULBEKYAN PHARM D (PRESIDENT/CEO)
(818) 743-4373
Entity
Organization
Contact information
Practice address
6727 ODESSA AVE STE 201, LAKE BALBOA, CA 91406-5747
(818) 743-4373
(818) 475-1611
Mailing address
6727 ODESSA AVE STE 201, LAKE BALBOA, CA 91406-5747
(818) 743-4373
(818) 475-1611
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY58941
BOARD OF PHARMACY
CA
Enumeration date
03/28/2024
Last updated
06/05/2024
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