Provider Demographics
NPI:1639171317
Name:RELIABLE PHARMACY
Entity Type:Organization
Organization Name:RELIABLE PHARMACY
Other - Org Name:RELIABLE PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT MANAGING PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:NAZIRI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-885-7722
Mailing Address - Street 1:18350 ROSCOE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4146
Mailing Address - Country:US
Mailing Address - Phone:818-885-7722
Mailing Address - Fax:818-349-6576
Practice Address - Street 1:18350 ROSCOE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4146
Practice Address - Country:US
Practice Address - Phone:818-885-7722
Practice Address - Fax:818-349-6576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY20952Medicaid
CAPHY20952Medicaid