Provider Demographics
NPI:1346384195
Name:PIROOZ PHARMACY, INC.
Entity Type:Organization
Organization Name:PIROOZ PHARMACY, INC.
Other - Org Name:BARRINGTON-WILSHIRE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRATARY
Authorized Official - Prefix:MR
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:PIROOZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-473-3323
Mailing Address - Street 1:11701 WILSHIRE BLVD
Mailing Address - Street 2:STORE # 3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1546
Mailing Address - Country:US
Mailing Address - Phone:310-473-3323
Mailing Address - Fax:310-473-3473
Practice Address - Street 1:11701 WILSHIRE BLVD
Practice Address - Street 2:STORE # 3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1546
Practice Address - Country:US
Practice Address - Phone:310-473-3323
Practice Address - Fax:310-473-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY41644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA416440Medicaid
1116170001Medicare ID - Type Unspecified