Healthcare Provider Details

I. General information

NPI: 1568744647
Provider Name (Legal Business Name): PLATINUM PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 WESTWOOD BLVD
LOS ANGELES CA
90024-4940
US

IV. Provider business mailing address

1377 WESTWOOD BLVD
LOS ANGELES CA
90024-4940
US

V. Phone/Fax

Practice location:
  • Phone: 310-444-7979
  • Fax: 310-444-7971
Mailing address:
  • Phone: 310-444-7979
  • Fax: 310-444-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number54308
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARYEM AKHAVANROOFIGAR
Title or Position: OWNER/PIC
Credential: RPH
Phone: 310-709-3581