Provider Demographics
NPI:1497130405
Name:ABC PHARMACY OF BEVERLY HILLS INC
Entity Type:Organization
Organization Name:ABC PHARMACY OF BEVERLY HILLS INC
Other - Org Name:ABC PHARMACY OF BEVERLY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ARKAIDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KHAIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-777-0052
Mailing Address - Street 1:9033 WILSHIRE BLVD
Mailing Address - Street 2:#102
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1837
Mailing Address - Country:US
Mailing Address - Phone:310-777-0052
Mailing Address - Fax:310-777-0149
Practice Address - Street 1:9033 WILSHIRE BLVD
Practice Address - Street 2:#102
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1837
Practice Address - Country:US
Practice Address - Phone:310-777-0052
Practice Address - Fax:310-777-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 536013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy