Healthcare Provider Details

I. General information

NPI: 1235126038
Provider Name (Legal Business Name): VICTORY DISCOUNT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12922 VICTORY BLVD STE A
N HOLLYWOOD CA
91606-2924
US

IV. Provider business mailing address

12922 VICTORY BLVD STE A
N HOLLYWOOD CA
91606-2924
US

V. Phone/Fax

Practice location:
  • Phone: 818-752-9888
  • Fax: 818-752-0492
Mailing address:
  • Phone: 818-752-9888
  • Fax: 818-752-0492

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 NumberPHY41446
License Number StateCA

VIII. Authorized Official

Name: FARHAD YASSINI
Title or Position: PIC AND PRESIDENT
Credential:
Phone: 818-752-9888