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General NPI Number Information
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NPI Number | 1568004083
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Entity Type | Organization
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Legal Business Name | AHAVA PHARMACY INC
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 8835 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-3301
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Country | US
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Telephone | 310-299-8079
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Fax |
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Provider Business Mailing Address
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Address Line | 8835 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-3301
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Country | US
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Telephone | 310-299-8079
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Fax | 310-299-8078
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Authorized Official
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Title or Position | PRESIDENT/CEO/CFO/SECRETARY/DIRECTO
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Name | ASHKAN GHOULIAN MOGHADAM
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Credential | PHARM D
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Telephone | 310-299-8079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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