Organization
IM PHARMACY INC
Active
Other names
KD Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IGOR MARTINOV (PRESIDENT/PIC)
(818) 335-4000
Entity
Organization
Contact information
Practice address
10970 SHERMAN WAY STE 110, BURBANK, CA 91505-1003
(818) 847-8600
(818) 847-8698
Mailing address
10970 SHERMAN WAY, SUITE 110, BURBANK, CA 91505-1002
(818) 847-8600
(818) 847-8698
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY51128
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY51128
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51128
RETAIL PHARMACY PERMIT
CA
01
—
5635012
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/17/2009
Last updated
12/14/2012
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