Organization
CASA BLANCA PHARMACY INC
Active
Other names
Casa Blanca Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE GEVORKYAN (CEO/OWNER)
(818) 698-4390
Entity
Organization
Contact information
Practice address
2012 GLENOAKS BLVD, SAN FERNANDO, CA 91340-1625
(818) 698-4390
(818) 698-4387
Mailing address
2012 GLENOAKS BLVD, SAN FERNANDO, CA 91340-1625
(818) 698-4390
(818) 698-4387
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54575
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153949
PK
—
Enumeration date
08/26/2015
Last updated
10/31/2016
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