Organization
N E A CORPORATION
Active
Other names
St Mary's Pharmacy and Medical Supplies
Organization subpart
No
Provider details
NPI number
Authorized official
VARTAN GEVORKIAN (VICE PRESIDENT)
(323) 722-0778
Entity
Organization
Contact information
Practice address
800 S CENTRAL AVE STE A, GLENDALE, CA 91204-4370
(323) 722-0778
(323) 278-1121
Mailing address
5207 HOLLYWOOD BLVD, LOS ANGELES, CA 90027-4908
(323) 461-9451
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
50049
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0598586
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/19/2007
Last updated
11/08/2010
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