=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437146453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GJPL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 20TH ST SUITE 120
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-453-6553
-----------------------------------------------------
Fax | 310-828-5645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 20TH ST SUITE #120
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-2050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-453-6553
-----------------------------------------------------
Fax | 310-828-5645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MRS. FARNAZ MAHDAVI MAVADAT
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 310-453-6553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 42814
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------