Healthcare Provider Details

I. General information

NPI: 1497130405
Provider Name (Legal Business Name): ABC PHARMACY OF BEVERLY HILLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 WILSHIRE BLVD #102
BEVERLY HILLS CA
90211-1837
US

IV. Provider business mailing address

9033 WILSHIRE BLVD #102
BEVERLY HILLS CA
90211-1837
US

V. Phone/Fax

Practice location:
  • Phone: 310-777-0052
  • Fax: 310-777-0149
Mailing address:
  • Phone: 310-777-0052
  • Fax: 310-777-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 53601
License Number StateCA

VIII. Authorized Official

Name: DR. ARKAIDY E KHAIMOV
Title or Position: PRESIDENT/PIC
Credential: PHARM D
Phone: 310-777-0052