Provider Demographics
NPI:1346628047
Name:FUSION IV PHARMACEUTICALS INC.
Entity Type:Organization
Organization Name:FUSION IV PHARMACEUTICALS INC.
Other - Org Name:AXIA PHARMACEUTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHEDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:877-685-8222
Mailing Address - Street 1:1990 WESTWOOD BLVD # 135
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4650
Mailing Address - Country:US
Mailing Address - Phone:877-685-8222
Mailing Address - Fax:866-711-3106
Practice Address - Street 1:1990 WESTWOOD BLVD # 135
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4650
Practice Address - Country:US
Practice Address - Phone:877-685-8222
Practice Address - Fax:866-711-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY537263336C0004X
CALSC1008553336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7591170001Medicare NSC