Healthcare Provider Details

I. General information

NPI: 1922029974
Provider Name (Legal Business Name): HOTEL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 WILSHIRE BLVD 102 B
LOS ANGELES CA
90025-1200
US

IV. Provider business mailing address

PO BOX 25817
LOS ANGELES CA
90025-0817
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-4588
  • Fax: 310-826-3709
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY39100
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BEHZAD NIAKAN
Title or Position: PIC
Credential:
Phone: 310-826-4588