Provider Demographics
NPI:1578651634
Name:KAMASHIANS PHARMACY INC
Entity type:Organization
Organization Name:KAMASHIANS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARX
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMASHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-360-2124
Mailing Address - Street 1:10515 BALBOA BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-360-2124
Mailing Address - Fax:818-360-2126
Practice Address - Street 1:10515 BALBOA BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344
Practice Address - Country:US
Practice Address - Phone:818-360-2124
Practice Address - Fax:818-360-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY434473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA434470Medicaid
0823080001Medicare ID - Type Unspecified