MEDICARE: CIENEGA PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336H0001X	Home Infusion Therapy Pharmacy
2	3336S0011X	Specialty Pharmacy
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PHY46672	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2112850	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134280456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIENEGA PHARMACY INC

Provider Business Mailing Address
First Line	:	7360 SANTA MONICA BLVD
Second Line	:	SUITE 101
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6619
Country	:	US
Telephone Number	:	310-360-9969
Fax Number	:	310-360-9959

Provider Business Practice Location Address
First Line	:	7360 SANTA MONICA BLVD
Second Line	:	SUITE 101
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6619
Country	:	US
Telephone Number	:	310-360-9969
Fax Number	:	310-360-9959

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AFREH KHAZAEE
Credential	:
Telephone Number	:	310-360-9969

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	04/01/2013

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Directions to “CIENEGA PHARMACY INC ” Practice Location

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