NPIMap

Organization Active NPI

Normandy Pharmacy Inc

  • Pharmacist
  • Los Angeles, CA
National Provider Identifier
1497742399
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PHY43795 Issued in CA
Legal business name
NORMANDY PHARMACY INC
Practice address
5112 Hollywood Blvd
Suite 104
Los Angeles, CA 90027-6124
Phone
(323) 913-3337
Fax
(323) 913-0318
NPI assigned
Oct 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Authorized official

Name
Dr. Petros Nazarian
Title
President
Phone
(323) 913-3337

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X PHY43795 CA Primary

Addresses

Primary practice location

5112 Hollywood Blvd
Suite 104
Los Angeles, CA 90027-6124

Mailing address

5112 Hollywood Blvd
Suite 104
Los Angeles, CA 90027-6124
Phone (323) 913-3337

Other identifiers 1

IdentifierTypeStateIssuer
PHA437950MedicaidCA

Other names 1

  • Normandy Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930085365 CA DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 1355462706 Practice locations: Los Angeles, CA
O20240104001465 CA Part B Supplier - Mass Immunization (Roster Biller Only) 1355462706 Practice locations: Los Angeles, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Normandy Pharmacy Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

5112 Hollywood Blvd
Ste 104
Los Angeles, CA 90027
Phone (323) 913-3337

12914 Sherman Way
#B
North Hollywood, CA 91605
Phone (818) 358-4300

NPI Registry JSON

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1497742399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5112 HOLLYWOOD BLVD",
            "address_2": "SUITE 104",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276124",
            "telephone_number": "323-913-3337",
            "fax_number": "323-913-0318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5112 HOLLYWOOD BLVD",
            "address_2": "SUITE 104",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276124",
            "telephone_number": "323-913-3337",
            "fax_number": "323-913-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORMANDY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A",
        "authorized_official_last_name": "NAZARIAN",
        "authorized_official_first_name": "PETROS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-913-3337",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "PHY43795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA437950",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Normandy Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; 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.