Healthcare Provider Details

I. General information

NPI: 1265511661
Provider Name (Legal Business Name): UNITED PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 S ROBERTSON BLVD
LOS ANGELES CA
90035-1403
US

IV. Provider business mailing address

1129 S ROBERTSON BLVD
LOS ANGELES CA
90035-1403
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-0247
  • Fax: 310-247-0248
Mailing address:
  • Phone: 310-247-0247
  • Fax: 310-247-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46362
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY 46362
License Number StateCA

VIII. Authorized Official

Name: FARID RAPHAEL POURMORADY
Title or Position: PRESIDENT
Credential: RPH
Phone: 310-247-0247