MEDICARE: COLFAX PHARMACEUTICAL 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1669265286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLFAX PHARMACEUTICAL INC

Provider Business Mailing Address
First Line	:	11980 SAN VICENTE BLVD STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6602
Country	:	US
Telephone Number	:	310-820-1496
Fax Number	:	310-820-4186

Provider Business Practice Location Address
First Line	:	11980 SAN VICENTE BLVD STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6602
Country	:	US
Telephone Number	:	310-820-1496
Fax Number	:	310-820-4186

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	DR. BENYAMIN SOLAIMAN TEHRANI
Credential	:	PHARM. D
Telephone Number	:	310-820-1496

Provider Enumeration Date	:	05/27/2025
Last Update Date	:	06/13/2025

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