=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659437986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARC MEDICAL PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 01/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6200 WILSHIRE BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-938-2854
-----------------------------------------------------
Fax | 323-938-1790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6200 WILSHIRE BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-938-2854
-----------------------------------------------------
Fax | 323-938-1790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SAEED MAKHANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-938-2854
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY16735
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------