Organization
IV LEAGUE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARZIN KHALKHALI PHD (PRESIDENT)
(310) 645-1500
Entity
Organization
Contact information
Practice address
6076 BRISTOL PARKWAY, #104, CULVER CITY, CA 90230-8802
(310) 645-1500
(310) 645-6464
Mailing address
PO BOX 341890, LOS ANGELES, CA 90034-8802
(310) 645-1500
(310) 645-6464
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHY45770
CA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PHY45770
CA
3336H0001X
Home Infusion Therapy Pharmacy
Primary
PHY45770
CA
3336S0011X
Specialty Pharmacy
PHY45770
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA457700
—
CA
01
—
PHY45770
PHARMACY LICENSE
CA
Enumeration date
01/17/2007
Last updated
12/23/2009
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