MMG Team Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

MMG TEAM INC

Doing business as

WESTCOAST SPECIALTY PHARMACY

Practice address

6727 Odessa Ave Ste 201
Lake Balboa, CA 91406-5747

Phone

(818) 743-4373

Fax

(818) 475-1611

NPI assigned

Mar 28, 2024

Organization subpart

No

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

Authorized official

Name

Marine Mananyan Gyulbekyan, PHARM DNPI 1114686912

Title

President/Ceo

Phone

(818) 743-4373

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• WESTCOAST SPECIALTY 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

Practitioners 1

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

• Marine Mananyan Gyulbekyan, PHARMACIST

  • Pharmacist
  • Glendale, CA
  • NPI 1114686912
  NPD Authorized official

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

{
    "created_epoch": "1711584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1689425514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6727 ODESSA AVE STE 201",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914065747",
            "telephone_number": "818-743-4373",
            "fax_number": "818-475-1611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6727 ODESSA AVE STE 201",
            "city": "LAKE BALBOA",
            "state": "CA",
            "postal_code": "914065747",
            "telephone_number": "818-743-4373",
            "fax_number": "818-475-1611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMG TEAM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-28",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "MANANYAN GYULBEKYAN",
        "authorized_official_first_name": "MARINE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "818-743-4373",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "PHY58941",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WESTCOAST SPECIALTY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WESTCOAST SPECIALTY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Pharmacy in Lake Balboa, CA
• Providers in Lake Balboa, CA by specialty
• Long Term Care Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.