Provider Demographics
NPI:1710012919
Name:LAUDEN PHARMACY, INC.
Entity Type:Organization
Organization Name:LAUDEN PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:REYHANI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:831-462-9880
Mailing Address - Street 1:1820 41ST AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2516
Mailing Address - Country:US
Mailing Address - Phone:831-462-9880
Mailing Address - Fax:831-462-9998
Practice Address - Street 1:1820 41ST AVE
Practice Address - Street 2:SUITE F
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2516
Practice Address - Country:US
Practice Address - Phone:831-462-9880
Practice Address - Fax:831-462-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY43209333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA432090Medicaid