MEDICARE: DRUGSTORE CAFE 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	3336C0003X	Community/Retail Pharmacy	49229	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5632307	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1194975193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRUGSTORE CAFE INC

Provider Business Mailing Address
First Line	:	8501 WILSHIRE BLVD
Second Line	:	STE 105
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8501 WILSHIRE BLVD
Second Line	:	STE 105
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3150
Country	:	US
Telephone Number	:	310-657-4500
Fax Number	:	310-657-4526

Authorized Official
Title or Position	:	OWNER
Name	:	KAMBIZ BARKHORADARZADEH
Credential	:
Telephone Number	:	310-657-4500

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	10/15/2008

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Directions to “DRUGSTORE CAFE INC ” Practice Location

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