Provider Demographics
NPI:1568051183
Name:MASTERS COMPOUNDING PHARMACY, INC.
Entity Type:Organization
Organization Name:MASTERS COMPOUNDING PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRAKHOR KALIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-978-6785
Mailing Address - Street 1:8600 W 3RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3338
Mailing Address - Country:US
Mailing Address - Phone:424-235-4210
Mailing Address - Fax:
Practice Address - Street 1:8600 W 3RD ST STE 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3338
Practice Address - Country:US
Practice Address - Phone:424-235-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy