Provider Demographics
NPI:1881011633
Name:DIABLO PHARMACY
Entity Type:Organization
Organization Name:DIABLO PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARVIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHANGIRIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:925-237-9939
Mailing Address - Street 1:2301 CAMINO RAMON STE 190
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2060
Mailing Address - Country:US
Mailing Address - Phone:925-237-9939
Mailing Address - Fax:925-237-9938
Practice Address - Street 1:2301 CAMINO RAMON STE 190
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2060
Practice Address - Country:US
Practice Address - Phone:925-237-9939
Practice Address - Fax:925-237-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY517563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy