Provider Demographics
NPI:1770926610
Name:VIP COMPOUNDING PHARMACY CORP
Entity type:Organization
Organization Name:VIP COMPOUNDING PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:POUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARZADFAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:661-777-7770
Mailing Address - Street 1:23206 LYONS AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2667
Mailing Address - Country:US
Mailing Address - Phone:661-777-7770
Mailing Address - Fax:661-777-7776
Practice Address - Street 1:23206 LYONS AVE
Practice Address - Street 2:STE 112
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2667
Practice Address - Country:US
Practice Address - Phone:661-777-7770
Practice Address - Fax:661-777-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy