Provider Demographics
NPI:1689206047
Name:OLYMPIC COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:OLYMPIC COMMUNITY PHARMACY INC
Other - Org Name:OLYMPIC COMMUNITY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/CFO/SECRETARY/DIRECTO
Authorized Official - Prefix:
Authorized Official - First Name:AJMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHMIRZAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-708-0161
Mailing Address - Street 1:9117 W OLYMIC BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3507
Mailing Address - Country:US
Mailing Address - Phone:310-708-0161
Mailing Address - Fax:310-708-0163
Practice Address - Street 1:9117 W OLYMIC BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3507
Practice Address - Country:US
Practice Address - Phone:310-708-0161
Practice Address - Fax:310-708-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy