Organization
MIRACLE PHARMACY INC.
Active
Other names
West Vern Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ANAIT DANIELIAN (PRESIDENT)
(818) 642-3034
Entity
Organization
Contact information
Practice address
2490 HONOLULU AVE # 140B, MONTROSE, CA 91020-1800
(818) 642-3034
Mailing address
2490 HONOLULU AVE # 140B, MONTROSE, CA 91020-1800
(818) 642-3034
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA460660
—
CA
Enumeration date
05/23/2007
Last updated
08/22/2020
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