Healthcare Provider Details

I. General information

NPI: 1902950348
Provider Name (Legal Business Name): MAZDEYASNAN PHARMACEUTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 COOPER RD
OXNARD CA
93030-5445
US

IV. Provider business mailing address

801 COOPER RD
OXNARD CA
93030-5445
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-8644
  • Fax: 805-483-2731
Mailing address:
  • Phone: 805-483-8644
  • Fax: 805-483-2731

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 NumberPHY46437
License Number StateCA

VIII. Authorized Official

Name: BABAK MAZDEYASNAN
Title or Position: OWNER
Credential: PHARMD
Phone: 805-483-8644