Provider Demographics
NPI:1659199529
Name:ONCARE PHARMACY LLC
Entity type:Organization
Organization Name:ONCARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRAKHOR KALIMI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-853-1626
Mailing Address - Street 1:1030 S FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4401
Mailing Address - Country:US
Mailing Address - Phone:310-853-1626
Mailing Address - Fax:310-853-8081
Practice Address - Street 1:1030 S FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4401
Practice Address - Country:US
Practice Address - Phone:310-853-1626
Practice Address - Fax:310-853-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY60024OtherBOARD OF PHARMACY