Provider Demographics
NPI:1578544656
Name:MOAZZEM H. CHOWDHURY
Entity Type:Organization
Organization Name:MOAZZEM H. CHOWDHURY
Other - Org Name:DESERT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOAZZEM
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:661-948-0822
Mailing Address - Street 1:204 W AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3684
Mailing Address - Country:US
Mailing Address - Phone:661-948-0822
Mailing Address - Fax:661-948-0844
Practice Address - Street 1:204 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3684
Practice Address - Country:US
Practice Address - Phone:661-948-0822
Practice Address - Fax:661-948-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 46289333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 462890Medicaid
5155490001Medicare ID - Type Unspecified
CA0589955Medicare UPIN