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General NPI Number Information
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NPI Number | 1538407796
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Entity Type | Organization
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Legal Business Name | MEDLIFE PHARMACY & COMPOUNDING,INC.
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 6644 IRVINE CENTER DR
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City | IRVINE
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State | CA
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Zip | 92618-2117
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Country | US
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Telephone | 949-502-7272
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Fax | 949-502-7250
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Provider Business Mailing Address
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Address Line | 6644 IRVINE CENTER DR
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City | IRVINE
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State | CA
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Zip | 92618-2117
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Country | US
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Telephone | 949-502-7272
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Fax | 949-502-7250
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Authorized Official
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Title or Position | CEO
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Name | DR. SHAR SHAHRZAD BAHRI ESHRAGHI
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Credential | PHARM.D.
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Telephone | 949-212-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY51156
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License Number State | CA
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