Organization
PICO SQUARE PHARMACY RX INC
Active
Organization
PICO SQUARE PHARMACY RX INC
Active
Other names
PICO SQUARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAHIN AGHABABASHIRAZI PHARM D (PRESIDENT/PIC)
(213) 385-0076
Entity
Organization
Contact information
Practice address
2334 W PICO BLVD, LOS ANGELES, CA 90006-4002
(213) 385-0076
(213) 385-0087
Mailing address
2334 W PICO BLVD, LOS ANGELES, CA 90006-4002
(213) 385-0076
(213) 385-0087
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY50810
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY50810
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY50810
RETAIL PHARMACY PERMIT
CA
Enumeration date
06/21/2012
Last updated
07/17/2012
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