=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578544656
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOAZZEM H. CHOWDHURY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 W AVENUE J
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93534-3684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-948-0822
-----------------------------------------------------
Fax | 661-948-0844
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 W AVENUE J
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93534-3684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-948-0822
-----------------------------------------------------
Fax | 661-948-0844
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST, OWNER
-----------------------------------------------------
Name | MR. MOAZZEM H. CHOWDHURY
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 661-948-0822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PHY 46289
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------