Provider Demographics
NPI:1679165484
Name:RA INVESTMENT CAPITAL,INC
Entity Type:Organization
Organization Name:RA INVESTMENT CAPITAL,INC
Other - Org Name:OPTIMUM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAMZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-704-7999
Mailing Address - Street 1:1080 S LA CIENEGA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2686
Mailing Address - Country:US
Mailing Address - Phone:310-704-7999
Mailing Address - Fax:
Practice Address - Street 1:1080 S LA CIENEGA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2686
Practice Address - Country:US
Practice Address - Phone:310-704-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58083OtherBOARD OF PHARMACY