Canyon RX Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

CANYON RX INC

Practice address

12117 Magnolia Blvd
Valley Village, CA 91607

Phone

(818) 927-4249

Fax

(818) 927-4215

NPI assigned

Sep 12, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Erry Astourian

Title

Ceo

Phone

(818) 395-5509

Specialties & licenses 1

Addresses

Other names 1

• 101 Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1568246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613347200000",
    "number": "1689224545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12117 MAGNOLIA BLVD",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "91607",
            "telephone_number": "818-927-4249",
            "fax_number": "818-927-4215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12117 MAGNOLIA BLVD",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "91607",
            "telephone_number": "818-927-4249",
            "fax_number": "818-927-4215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON RX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-12",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A",
        "authorized_official_last_name": "ASTOURIAN",
        "authorized_official_first_name": "ERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-395-5509",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "101 Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Valley Village, CA
• Providers in Valley Village, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.