Organization
MEDPRO PHARMACY INC
Active
Other names
MEDPRO PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SIAVASH AHDOOT PHARM D (PRESIDENT/PHARMACIST)
(323) 939-8300
Entity
Organization
Contact information
Practice address
7129 W SUNSET BLVD, LOS ANGELES, CA 90046-4411
(323) 969-8300
(323) 969-8400
Mailing address
7129 W SUNSET BLVD, LOS ANGELES, CA 90046-4411
(323) 969-8300
(323) 969-8400
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY50438
CA
3336C0003X
Community/Retail Pharmacy
Primary
PHY50438
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639103807
—
CA
01
—
5622560
NCPDP PROVIDER IDENTIFICATION NUMBER
—
01
—
PHY 50438
STATE BOARD OF PHARMACY RETAIL PERMIT
CA
Enumeration date
07/11/2006
Last updated
08/30/2011
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