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Organization
VICTORY DISCOUNT PHARMACY INC
Active
Organization
VICTORY DISCOUNT PHARMACY INC
Active
Other names
VICTORY DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
FARHAD YASSINI (PIC AND PRESIDENT)
(818) 752-9888
Entity
Organization
Contact information
Practice address
12922 VICTORY BLVD, STE A, N HOLLYWOOD, CA 91606-2924
(818) 752-9888
(818) 752-0492
Mailing address
12922 VICTORY BLVD, STE A, N HOLLYWOOD, CA 91606-2924
(818) 752-9888
(818) 752-0492
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY41446
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0532641
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
PHA414460
—
CA
Enumeration date
10/05/2005
Last updated
09/17/2010
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