Provider Demographics
NPI:1902891773
Name:ASTRAL PHARMACY INC
Entity Type:Organization
Organization Name:ASTRAL PHARMACY INC
Other - Org Name:ASTRAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAYANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRAKOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:323-466-9931
Mailing Address - Street 1:PO BOX 4070
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91503-4070
Mailing Address - Country:US
Mailing Address - Phone:323-466-9931
Mailing Address - Fax:323-466-9932
Practice Address - Street 1:6368 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6320
Practice Address - Country:US
Practice Address - Phone:323-466-9931
Practice Address - Fax:323-466-9932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY421713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0572140OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA421710Medicaid
1178990001Medicare NSC