Provider Demographics
NPI:1568004083
Name:AHAVA PHARMACY INC
Entity Type:Organization
Organization Name:AHAVA PHARMACY INC
Other - Org Name:AHAVA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/CFO/SECRETARY/DIRECTO
Authorized Official - Prefix:
Authorized Official - First Name:ASHKAN
Authorized Official - Middle Name:GHOULIAN
Authorized Official - Last Name:MOGHADAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-299-8079
Mailing Address - Street 1:8835 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3301
Mailing Address - Country:US
Mailing Address - Phone:310-299-8079
Mailing Address - Fax:310-299-8078
Practice Address - Street 1:8835 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3301
Practice Address - Country:US
Practice Address - Phone:310-299-8079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy