Organization
S AMIR FARZAN TAVAKKOLI ISFAHANI
Active
Other names
Laguna Niguel HealthMart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SEID AMIR FARZAN TAVAKKOLI ISFAHANI (OWNER)
(256) 797-2552
Entity
Organization
Contact information
Practice address
27871 LA PAZ RD, LAGUNA NIGUEL, CA 92677-3920
(949) 360-1600
Mailing address
27871 LA PAZ RD, LAGUNA NIGUEL, CA 92677-3920
(949) 360-1600
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152883
PK
—
Enumeration date
06/30/2015
Last updated
07/07/2015
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