NPIMap

Organization Active NPI

Glendale West Drug Co Inc

  • Pharmacy
  • Glendale, CA
National Provider Identifier
1619965951
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHY43706 Issued in CA
Legal business name
GLENDALE WEST DRUG CO INC
Practice address
1109 S Glendale Ave
Glendale, CA 91205-5657
Phone
(818) 548-5157
Fax
(818) 548-1064
NPI assigned
Oct 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Malek Set Allahdadai
Title
President
Phone
(818) 548-5157

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PHY43706 CA Primary

Addresses

Primary practice location

1109 S Glendale Ave
Glendale, CA 91205-5657

Mailing address

1109 S Glendale Ave
Glendale, CA 91205-5657
Phone (818) 548-5157

Other identifiers 1

IdentifierTypeStateIssuer
PHA437060MedicaidCA

Other names 1

  • glendale west pharmacy and medical supply Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Glendale West Drug Co Inc2 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.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619965951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 S GLENDALE AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912055657",
            "telephone_number": "818-548-5157",
            "fax_number": "818-548-1064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 S GLENDALE AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912055657",
            "telephone_number": "818-548-5157",
            "fax_number": "818-548-1064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE WEST DRUG CO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALLAHDADAI",
        "authorized_official_first_name": "MALEK",
        "authorized_official_middle_name": "SET",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-548-5157",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY43706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA437060",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "glendale west pharmacy and medical supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 22, 2020; 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.