Provider Demographics
NPI:1558864991
Name:MIRACLE CARE PHARMACY INC
Entity Type:Organization
Organization Name:MIRACLE CARE PHARMACY INC
Other - Org Name:MIRACLE CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SIAMAK
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHRANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-773-2226
Mailing Address - Street 1:24355 LYONS AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2394
Mailing Address - Country:US
Mailing Address - Phone:310-773-2226
Mailing Address - Fax:844-270-2227
Practice Address - Street 1:24355 LYONS AVE STE 110
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2394
Practice Address - Country:US
Practice Address - Phone:310-773-2226
Practice Address - Fax:844-270-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy