Organization
PALISADES COMPOUNDING PHARMACY INC
Active
Other names
PALISADES COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SHAHRAM SOROUDI (PRESIDENT, OWNER)
(310) 777-2000
Entity
Organization
Contact information
Practice address
540 PALISADES DR, PACIFIC PALISADES, CA 90272-2844
(310) 454-4848
(310) 454-3838
Mailing address
540 PALISADES DR, PACIFIC PALISADES, CA 90272-2844
(310) 454-4848
(310) 454-3838
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
48986
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2113288
PK
—
Enumeration date
03/14/2008
Last updated
11/25/2014
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