Organization
ATHENOLAN PHARMACEUTICAL INC
Active
Other names
TAO WELLNESS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAHBOD ZARGAR PHARM D (SECRETARY/PIC)
(714) 593-5654
Entity
Organization
Contact information
Practice address
16931 BUSHARD ST, FOUNTAIN VALLEY, CA 92708-2819
(714) 593-5654
(714) 968-6893
Mailing address
16931 BUSHARD ST, FOUNTAIN VALLEY, CA 92708-2819
(714) 593-5654
(714) 968-6893
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56-47524
NCPDP
—
01
—
56916
BOARD OF PHARMACY PERMIT
CA
Enumeration date
04/04/2013
Last updated
09/23/2019
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