MEDICARE: THE DIENNET PHARMACY

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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy	PHY44310	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157498	OTHER		PK

General Provider Information

NPI Number	:	1346521390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DIENNET PHARMACY

Provider Business Mailing Address
First Line	:	9454 WILSHIRE BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2931
Country	:	US
Telephone Number	:	310-271-3621
Fax Number	:	310-271-3708

Provider Business Practice Location Address
First Line	:	9454 WILSHIRE BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2931
Country	:	US
Telephone Number	:	310-271-3621
Fax Number	:	310-271-3708

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	AFSHIN SHAMOONI
Credential	:
Telephone Number	:	310-271-3621

Provider Enumeration Date	:	09/05/2011
Last Update Date	:	07/07/2016

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Directions to “THE DIENNET PHARMACY ” Practice Location

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