Provider Demographics
NPI:1871736330
Name:MEGA MEMBER PHARMACY
Entity type:Organization
Organization Name:MEGA MEMBER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANATOLI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUZINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-350-4069
Mailing Address - Street 1:8306 WILSHIRE BLVD
Mailing Address - Street 2:3004
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2382
Mailing Address - Country:US
Mailing Address - Phone:323-350-4069
Mailing Address - Fax:
Practice Address - Street 1:6266 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1560
Practice Address - Country:US
Practice Address - Phone:323-350-4069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy