Organization
SUPER PHARM INC
Active
Other names
STATE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LUIZA MALOYAN (PRESIDENT/OWNER)
(818) 386-8555
Entity
Organization
Contact information
Practice address
15714 1/2 VANOWEN ST, VAN NUYS, CA 91406-5029
(818) 386-8555
(818) 387-6210
Mailing address
15714 1/2 VANOWEN ST, VAN NUYS, CA 91406-5029
(818) 386-8555
(818) 387-6210
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY55554
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56-47423
NCPDP
CA
01
—
PHY55554
BOARD OF PHARMACY PERMIT
CA
Enumeration date
05/02/2013
Last updated
05/04/2017
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