Provider Demographics
NPI:1487842738
Name:VENICE PHARMACY INC
Entity Type:Organization
Organization Name:VENICE PHARMACY INC
Other - Org Name:VENICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:PARNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-502-2503
Mailing Address - Street 1:1511 S VERMONT AVE # 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4505
Mailing Address - Country:US
Mailing Address - Phone:213-381-6087
Mailing Address - Fax:213-381-6085
Practice Address - Street 1:1511 S VERMONT AVE # 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4505
Practice Address - Country:US
Practice Address - Phone:213-381-6087
Practice Address - Fax:213-381-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY488233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5628384OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6126350001Medicare NSC