MEDICARE: WESTSIDE PHARMACY CORPORATION

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHY50065	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2121730	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790918324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE PHARMACY CORPORATION

Provider Business Mailing Address
First Line	:	11504 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3008
Country	:	US
Telephone Number	:	310-479-0200
Fax Number	:	310-479-0220

Provider Business Practice Location Address
First Line	:	11504 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3008
Country	:	US
Telephone Number	:	310-479-0200
Fax Number	:	310-479-0220

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FARZAD PIROOZ
Credential	:
Telephone Number	:	310-479-0200

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	04/20/2017

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Directions to “WESTSIDE PHARMACY CORPORATION ” Practice Location

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