Organization
PRX PHARMACORP
Active
Other names
ELEVATE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PAYAM SHABBOUI (PRESIDENT/CEO/PIC)
(310) 657-4090
Entity
Organization
Contact information
Practice address
8631 W 3RD ST STE 320E, LOS ANGELES, CA 90048-5901
(310) 657-4090
(310) 657-4790
Mailing address
8631 W 3RD ST STE 320E, LOS ANGELES, CA 90048-5901
(310) 657-4090
(310) 657-4790
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5634729
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
PHY59257
BOARD OF PHARMACY
CA
Enumeration date
06/17/2009
Last updated
03/26/2024
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