Individual provider Active NPI

Marine Mananyan Gyulbekyan, PHARMACIST

  • Pharmacist
  • Glendale, CA
National Provider Identifier
1114686912
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
80705 Issued in CA
Practice address
839 W Glenoaks Blvd
Glendale, CA 91202-2133
Phone
(818) 600-0777
NPI assigned
Dec 9, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 80705 CA Primary

Addresses

Primary practice location

839 W Glenoaks Blvd
Glendale, CA 91202-2133

Mailing address

839 W Glenoaks Blvd
Glendale, CA 91202-2133
Phone (818) 600-0777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
80705CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Primemed Pharmacy Inc CurrentSince Jul 24, 2022 Accepting new patients
MMG Team Inc Current Accepting new patients
Primemed Pharmacy Inc CurrentSince Jul 28, 2024 Accepting new patients

Locations

839 W Glenoaks Blvd
Glendale, CA 91202
Phone (818) 600-0777

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1114686912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "839 W GLENOAKS BLVD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912022133",
            "telephone_number": "818-600-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "839 W GLENOAKS BLVD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912022133",
            "telephone_number": "818-600-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANANYAN GYULBEKYAN",
        "first_name": "MARINE",
        "name_prefix": "Dr.",
        "credential": "PHARMACIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-09",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "80705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.