Provider Demographics
NPI:1639545304
Name:DORADO PHARMACY INC
Entity Type:Organization
Organization Name:DORADO PHARMACY INC
Other - Org Name:DORADO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DARROUJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-485-5554
Mailing Address - Street 1:13003 VAN NUYS BLVD
Mailing Address - Street 2:UNIT #E
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-8316
Mailing Address - Country:US
Mailing Address - Phone:818-485-5554
Mailing Address - Fax:818-485-5560
Practice Address - Street 1:13003 VAN NUYS BLVD STE E
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-8324
Practice Address - Country:US
Practice Address - Phone:818-485-5554
Practice Address - Fax:818-485-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY536853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639545304Medicaid