Octagon Pharmaceutical Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

51780 Issued in CA

Legal business name

OCTAGON PHARMACEUTICAL INC

Practice address

1809 Verdugo Blvd Ste 110
Glendale, CA 91208-1402

Phone

(818) 952-2108

Fax

(818) 952-2149

NPI assigned

Jun 15, 2006

Organization subpart

No

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

Authorized official

Name

Ellie Yazdi

Title

President/Pic

Phone

(818) 952-2108

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Verdugo Plaza Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470787200000",
    "number": "1972547719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 VERDUGO BLVD STE 110",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912081402",
            "telephone_number": "818-952-2108",
            "fax_number": "818-952-2149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 VERDUGO BLVD STE 110",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912081402",
            "telephone_number": "818-952-2108",
            "fax_number": "818-952-2149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCTAGON PHARMACEUTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2016-08-10",
        "status": "A",
        "authorized_official_last_name": "YAZDI",
        "authorized_official_first_name": "ELLIE",
        "authorized_official_title_or_position": "PRESIDENT/PIC",
        "authorized_official_telephone_number": "818-952-2108"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "51780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2145465",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Verdugo Plaza Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Glendale, CA
• Providers in Glendale, 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 Aug 10, 2016; 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.