Organization
ROUTE 66 PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMVEL KHACHATRYAN (PRESIDENT/CEO)
(760) 800-0107
Entity
Organization
Contact information
Practice address
821 W BROADWAY ST, NEEDLES, CA 92363-2701
(760) 800-0108
(760) 800-0107
Mailing address
821 W BROADWAY ST, NEEDLES, CA 92363-2701
(760) 800-0107
(760) 800-0108
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY60501
BOARD OF PHARMACY
CA
Enumeration date
01/09/2025
Last updated
04/30/2026
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