MEDICARE: PHARMACORP, 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	PHY41968	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0578558	OTHER	CA	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831254747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACORP, INC

Provider Business Mailing Address
First Line	:	2530B SAN VICENTE BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90402-2321
Country	:	US
Telephone Number	:	310-393-0201
Fax Number	:	310-394-2712

Provider Business Practice Location Address
First Line	:	2530B SAN VICENTE BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90402-2321
Country	:	US
Telephone Number	:	310-393-0201
Fax Number	:	310-394-2712

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HOMAYOUN NAMJO
Credential	:	PHARM.D
Telephone Number	:	310-393-0202

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	10/01/2024

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Directions to “PHARMACORP, INC ” Practice Location

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