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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