Organization
CIENEGA PHARMACY INC
Active
Organization
CIENEGA PHARMACY INC
Active
Other names
CIENEGA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AFREH KHAZAEE (PRESIDENT)
(310) 360-9969
Entity
Organization
Contact information
Practice address
7360 SANTA MONICA BLVD, SUITE 101, WEST HOLLYWOOD, CA 90046-6619
(310) 360-9969
(310) 360-9959
Mailing address
7360 SANTA MONICA BLVD, SUITE 101, WEST HOLLYWOOD, CA 90046-6619
(310) 360-9969
(310) 360-9959
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY46672
CA
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2112850
PK
—
05
—
PHA466720
—
CA
Enumeration date
12/12/2006
Last updated
04/01/2013
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