Provider Demographics
NPI:1538521588
Name:SPECTRA SCRIPTS PHARMACY INC
Entity type:Organization
Organization Name:SPECTRA SCRIPTS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTYR
Authorized Official - Middle Name:
Authorized Official - Last Name:MNATSAKANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-875-9944
Mailing Address - Street 1:567 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2858
Mailing Address - Country:US
Mailing Address - Phone:818-875-9944
Mailing Address - Fax:818-301-2171
Practice Address - Street 1:567 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2858
Practice Address - Country:US
Practice Address - Phone:818-875-9944
Practice Address - Fax:818-301-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
CAPHY542923336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159404OtherPK