Provider Demographics
NPI:1245723915
Name:FORTE RX PHARMACY
Entity type:Organization
Organization Name:FORTE RX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-584-5775
Mailing Address - Street 1:651 VIA ALONDRA STE 708
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8096
Mailing Address - Country:US
Mailing Address - Phone:805-427-9053
Mailing Address - Fax:805-233-3933
Practice Address - Street 1:651 VIA ALONDRA STE 708
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8096
Practice Address - Country:US
Practice Address - Phone:805-427-9053
Practice Address - Fax:805-233-3933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDFORTE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy