Organization
PV DRUG STORE
Active
Organization
PV DRUG STORE
Active
Other names
PV Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
VAHID BORDBAR PHARM.D (OWNER, PIC, AO)
(310) 462-1310
Entity
Organization
Contact information
Practice address
2325 PALOS VERDES DR W STE 220, PALOS VERDES ESTATES, CA 90274-2777
(424) 327-2990
(424) 327-2996
Mailing address
2325 PALOS VERDES DR W STE 220, PALOS VERDES ESTATES, CA 90274-2777
(424) 327-2990
(424) 327-2996
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY54543
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2162223
PK
—
Enumeration date
07/27/2016
Last updated
07/19/2018
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