Provider Demographics
NPI:1316368590
Name:PLATINUM PHARMACY INC
Entity Type:Organization
Organization Name:PLATINUM PHARMACY INC
Other - Org Name:FARMACIA SUPERIOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVANROOFIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-335-0737
Mailing Address - Street 1:1175 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1403
Mailing Address - Country:US
Mailing Address - Phone:424-335-0737
Mailing Address - Fax:424-335-0733
Practice Address - Street 1:1175 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1403
Practice Address - Country:US
Practice Address - Phone:424-335-0737
Practice Address - Fax:424-335-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-14
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556513336C0003X
CA524213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149371OtherPK
2143482OtherPK