Provider Demographics
NPI:1003347188
Name:ALLENWOOD MEDICAL PHARMACY, INC.
Entity Type:Organization
Organization Name:ALLENWOOD MEDICAL PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHORSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-275-5424
Mailing Address - Street 1:PO BOX 10142
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-3142
Mailing Address - Country:US
Mailing Address - Phone:310-275-5424
Mailing Address - Fax:310-275-5428
Practice Address - Street 1:9231 W OLYMPIC BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4658
Practice Address - Country:US
Practice Address - Phone:310-275-5424
Practice Address - Fax:310-275-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54631333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy