Provider Demographics
NPI:1629523410
Name:NEXTGEN PHARMACY INC
Entity Type:Organization
Organization Name:NEXTGEN PHARMACY INC
Other - Org Name:NEXTGEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAPOOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-776-1500
Mailing Address - Street 1:1039 W FLORENCE AVE
Mailing Address - Street 2:#102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2441
Mailing Address - Country:US
Mailing Address - Phone:323-776-1500
Mailing Address - Fax:323-776-1507
Practice Address - Street 1:1039 W FLORENCE AVE
Practice Address - Street 2:#102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2441
Practice Address - Country:US
Practice Address - Phone:323-776-1500
Practice Address - Fax:323-776-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy