Provider Demographics
NPI:1033239710
Name:AVALON PHARMACY INC.
Entity Type:Organization
Organization Name:AVALON PHARMACY INC.
Other - Org Name:AVALON PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ZAHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIDZADEH ARMAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-549-9393
Mailing Address - Street 1:1203 N AVALON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1203 N AVALON BLVD STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2646
Practice Address - Country:US
Practice Address - Phone:310-549-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY470023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA470020OtherMEDICAL
6386510001Medicare NSC