Provider Demographics
NPI:1598033169
Name:AVALON PHARMACY
Entity Type:Organization
Organization Name:AVALON PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ZAHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIDZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-549-5353
Mailing Address - Street 1:1203 N AVALON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2646
Mailing Address - Country:US
Mailing Address - Phone:310-549-5353
Mailing Address - Fax:310-549-9777
Practice Address - Street 1:1203 N AVALON BLVD STE A
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2646
Practice Address - Country:US
Practice Address - Phone:310-549-5353
Practice Address - Fax:310-549-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty