Healthcare Provider Details

I. General information

NPI: 1689206047
Provider Name (Legal Business Name): OLYMPIC COMMUNITY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/07/2024
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9117 W OLYMIC BLVD
BEVERLY HILLS CA
90212-3507
US

IV. Provider business mailing address

9117 W OLYMIC BLVD
BEVERLY HILLS CA
90212-3507
US

V. Phone/Fax

Practice location:
  • Phone: 310-708-0161
  • Fax: 310-708-0163
Mailing address:
  • Phone: 310-708-0161
  • Fax: 310-708-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AJMIN SHAHMIRZAYAN
Title or Position: PRESIDENT/CEO/CFO/SECRETARY/DIRECTO
Credential: PHARM D
Phone: 310-708-0161