Organization Active NPI

Doran Pharmacy Inc.

  • Community/Retail Pharmacy
  • Glendale, CA
National Provider Identifier
1376955781
Registry record updated Feb 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
DORAN PHARMACY INC.
Practice address
525 N Glendale Ave
Glendale, CA 91206-3307
Phone
(818) 291-4099
Fax
(818) 291-4097
NPI assigned
May 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2022

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

Authorized official

Name
Ms. Susanna Keshishian, PHARM.D.NPI 1972814796
Title
President
Phone
(818) 331-2932

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

525 N Glendale Ave
Glendale, CA 91206-3307

Mailing address

525 N Glendale Ave
Glendale, CA 91206-3307
Phone (818) 331-2932

Other identifiers 1

IdentifierTypeStateIssuer
CB235284MedicaidCA

Other names 1

  • Doran Pharmacy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20150630002606 CA Part B Supplier - Pharmacy 6507178795 Practice locations: Glendale, CA
O20180208000080 CA DME Supplier - Pharmacy 6507178795 Practice locations: Glendale, CA
O20240206000609 CA Part B Supplier - Mass Immunization (Roster Biller Only) 6507178795 Practice locations: Glendale, CA

National Provider Directory

National Provider Directory
Tax ID family
Doran Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

525 N Glendale Ave
Glendale, CA 91206
Phone (818) 291-4099

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644278400000",
    "number": "1376955781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 N GLENDALE AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912063307",
            "telephone_number": "818-331-2932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N GLENDALE AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912063307",
            "telephone_number": "818-291-4099",
            "fax_number": "818-291-4097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DORAN PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-20",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A",
        "authorized_official_last_name": "KESHISHIAN",
        "authorized_official_first_name": "SUSANNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-331-2932",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CB235284",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doran Pharmacy",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Doran Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.