Healthcare Provider Details

I. General information

NPI: 1346628047
Provider Name (Legal Business Name): FUSION IV PHARMACEUTICALS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 WESTWOOD BLVD # 135
LOS ANGELES CA
90025-4650
US

IV. Provider business mailing address

1990 WESTWOOD BLVD # 135
LOS ANGELES CA
90025-4650
US

V. Phone/Fax

Practice location:
  • Phone: 877-685-8222
  • Fax: 866-711-3106
Mailing address:
  • Phone: 877-685-8222
  • Fax: 866-711-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberLSC100855
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY53726
License Number StateCA

VIII. Authorized Official

Name: DR. NAVID VAHEDI
Title or Position: OWNER/PRESIDENT
Credential: PHARM D
Phone: 877-685-8222