Organization Active NPI

Lilac Pharmacy Inc

  • Community/Retail Pharmacy
  • Burbank, CA
National Provider Identifier
1700560885
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
LILAC PHARMACY INC
Practice address
2519 W Burbank Blvd
Burbank, CA 91505-2302
Phone
(818) 337-1123
Fax
(818) 337-1124
NPI assigned
Jun 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

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

Authorized official

Name
Haykuhi Havanjyan, PHARM DNPI 1316487564
Title
President/Ceo
Phone
(818) 337-1123

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

2519 W Burbank Blvd
Burbank, CA 91505-2302

Mailing address

2519 W Burbank Blvd
Burbank, CA 91505-2302
Phone (818) 337-1123

Other identifiers 1

IdentifierTypeStateIssuer
PHY60680OtherCABOARD OF PHARMACY

Other names 1

  • LILAC PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231201001122 CA DME Supplier - Pharmacy 8426406422 Practice locations: Simi Valley, CA

National Provider Directory

National Provider Directory

Locations

2519 W Burbank Blvd
Burbank, CA 91505
Phone (818) 736-5290

2139 Tapo St
Ste 213
Simi Valley, CA 93063
Phone (805) 526-0269

Practitioners & affiliated clinicians

Practitioners 1

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": "1686268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1700560885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2519 W BURBANK BLVD",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915052302",
            "telephone_number": "818-337-1123",
            "fax_number": "818-337-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2519 W BURBANK BLVD",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915052302",
            "telephone_number": "818-337-1123",
            "fax_number": "818-337-1124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILAC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-09",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "HAVANJYAN",
        "authorized_official_first_name": "HAYKUHI",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "818-337-1123",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY",
            "identifier": "PHY60680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LILAC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LILAC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burbank, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; 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.