Provider Demographics
NPI:1578701470
Name:PCCC INC
Entity Type:Organization
Organization Name:PCCC INC
Other - Org Name:PROFESSIONAL COMPOUNDING CENTER OF CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-346-7222
Mailing Address - Street 1:23101 SHERMAN PL
Mailing Address - Street 2:207
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2003
Mailing Address - Country:US
Mailing Address - Phone:818-346-7222
Mailing Address - Fax:818-347-7222
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:207
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2003
Practice Address - Country:US
Practice Address - Phone:818-346-7222
Practice Address - Fax:818-347-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5633830OtherNCPDP PROVIDER IDENTIFICATION NUMBER