Provider Demographics
NPI:1598139818
Name:PHARMAHERBIA, INC.
Entity Type:Organization
Organization Name:PHARMAHERBIA, INC.
Other - Org Name:CANOGA PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ZIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-601-2350
Mailing Address - Street 1:22330 SHERMAN WAY STE C3
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1066
Mailing Address - Country:US
Mailing Address - Phone:818-601-2350
Mailing Address - Fax:
Practice Address - Street 1:22330 SHERMAN WAY STE C3
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1066
Practice Address - Country:US
Practice Address - Phone:818-601-2350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY370653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9775823Medicaid