MEDICARE: DR N VAHEDI PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	3336M0002X	Mail Order Pharmacy
4	3336S0011X	Specialty Pharmacy	PHY49937	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2120895	OTHER		PK

General Provider Information

NPI Number	:	1043447204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR N VAHEDI PHARMACY INC

Provider Business Mailing Address
First Line	:	2001 WESTWOOD BLVD STE A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6328
Country	:	US
Telephone Number	:	310-204-6676
Fax Number	:	310-204-6678

Provider Business Practice Location Address
First Line	:	2001 WESTWOOD BLVD STE A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6328
Country	:	US
Telephone Number	:	310-204-6676
Fax Number	:	310-204-6678

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	NAVID VAHEDI
Credential	:
Telephone Number	:	310-877-9393

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	02/22/2017

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