Provider Demographics
NPI:1326049867
Name:FARDIN DADVAND
Entity Type:Organization
Organization Name:FARDIN DADVAND
Other - Org Name:PHARMACY 2000
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FARDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DADVAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-234-9991
Mailing Address - Street 1:1646 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5604
Mailing Address - Country:US
Mailing Address - Phone:310-234-9991
Mailing Address - Fax:310-234-1299
Practice Address - Street 1:1646 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5604
Practice Address - Country:US
Practice Address - Phone:310-234-9991
Practice Address - Fax:310-234-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44494333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA444940Medicaid
CA5469510001Medicare NSC