Provider Demographics
NPI:1841325685
Name:FIVE ANGELS CORP
Entity type:Organization
Organization Name:FIVE ANGELS CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOHARNIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-277-8388
Mailing Address - Street 1:PO BOX 5057
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-9057
Mailing Address - Country:US
Mailing Address - Phone:323-277-8388
Mailing Address - Fax:323-277-8384
Practice Address - Street 1:3074 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5828
Practice Address - Country:US
Practice Address - Phone:323-277-8388
Practice Address - Fax:323-277-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY409163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy