Provider Demographics
NPI:1922029974
Name:HOTEL PHARMACY INC
Entity Type:Organization
Organization Name:HOTEL PHARMACY INC
Other - Org Name:AMHERST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NIAKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-826-4588
Mailing Address - Street 1:PO BOX 25817
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12200 WILSHIRE BLVD
Practice Address - Street 2:102 B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1200
Practice Address - Country:US
Practice Address - Phone:310-826-4588
Practice Address - Fax:310-826-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY39100333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0538744OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA391000Medicaid
0825240001Medicare ID - Type Unspecified
CAPHA391000Medicaid