Provider Demographics
NPI:1205821253
Name:BEVERLY HILLS TOWER INC
Entity Type:Organization
Organization Name:BEVERLY HILLS TOWER INC
Other - Org Name:CENTURY CITY MEDICAL PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORVASH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-553-3434
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:CENTURY CITY MEDICAL PLAZA PHARMACY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-553-3434
Mailing Address - Fax:310-553-2237
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:CENTURY CITY MEDICAL PLAZA PHARMACY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-553-3434
Practice Address - Fax:310-553-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY36965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA369650Medicaid
CA5460560001Medicare NSC