MEDICARE: UNITED 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	3336L0003X	Long Term Care Pharmacy	PHY 46362	CA
2	333600000X	Pharmacy	PHY46362	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1265511661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED PHARMACY, INC

Provider Business Mailing Address
First Line	:	1129 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1403
Country	:	US
Telephone Number	:	310-247-0247
Fax Number	:	310-247-0248

Provider Business Practice Location Address
First Line	:	1129 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1403
Country	:	US
Telephone Number	:	310-247-0247
Fax Number	:	310-247-0248

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FARID RAPHAEL POURMORADY
Credential	:	RPH
Telephone Number	:	310-247-0247

Provider Enumeration Date	:	11/04/2006
Last Update Date	:	10/10/2013

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Directions to “UNITED PHARMACY, INC ” Practice Location

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