Provider Demographics
NPI:1023405339
Name:MEDICINE MAN PHARMACY INC
Entity type:Organization
Organization Name:MEDICINE MAN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHASSEMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:562-404-3100
Mailing Address - Street 1:13737 ARTESIA BLVD
Mailing Address - Street 2:#202
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8857
Mailing Address - Country:US
Mailing Address - Phone:562-404-3100
Mailing Address - Fax:562-404-4100
Practice Address - Street 1:13737 ARTESIA BLVD
Practice Address - Street 2:#202
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8857
Practice Address - Country:US
Practice Address - Phone:562-404-3100
Practice Address - Fax:562-404-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy