MEDICARE: ATAZAK 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	PHY53371	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2154379	OTHER		PK

General Provider Information

NPI Number	:	1619047826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATAZAK INC

Provider Business Mailing Address
First Line	:	2860 ARTESIA BLVD
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3421
Country	:	US
Telephone Number	:	310-371-7541
Fax Number	:	310-542-1488

Provider Business Practice Location Address
First Line	:	2860 ARTESIA BLVD
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3421
Country	:	US
Telephone Number	:	310-371-7541
Fax Number	:	310-542-1488

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AHMED ATALLAH
Credential	:
Telephone Number	:	310-951-4456

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/10/2016

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Directions to “ATAZAK INC ” Practice Location

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