Organization
PHAST PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AYMAN MOHAMED RPH (PHARMACIST IN CHARGE/OWNER)
(661) 578-6500
Entity
Organization
Contact information
Practice address
1121 W COLUMBUS ST, BAKERSFIELD, CA 93301-1105
(661) 527-2030
Mailing address
1121 W COLUMBUS ST, BAKERSFIELD, CA 93301-1105
(661) 578-6500
(661) 578-6501
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY55546
CA
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LSC101270
STERILE COMPOUNDING LICENSE
CA
01
—
PHY55546
CALIFORNIA BOARD OF PHARMACY
CA
Enumeration date
11/22/2017
Last updated
10/11/2019
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