Organization
BDO CORPORATION
Active
Other names
FAIRFAX PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY VAYBERMAN (PRESIDENT)
(323) 565-8622
Entity
Organization
Contact information
Practice address
1111 N FAIRFAX AVE STE 110, WEST HOLLYWOOD, CA 90046-5363
(323) 656-9622
(323) 656-9718
Mailing address
1111 N FAIRFAX AVE STE 110, WEST HOLLYWOOD, CA 90046-5363
(323) 656-9622
(323) 656-9718
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY41877
CA
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1994763
PK
—
05
—
PHA418770
—
CA
Enumeration date
07/28/2005
Last updated
02/27/2017
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