Bdo Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY41877 Issued in CA

Legal business name

BDO CORPORATION

Doing business as

Fairfax Pharmacy

Practice address

1111 N Fairfax Ave Ste 110
West Hollywood, CA 90046-5363

Phone

(323) 656-9622

Fax

(323) 656-9718

NPI assigned

Jul 28, 2005

Last updated

Feb 27, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gregory Vayberman

Title

President

Phone

(323) 565-8622

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• FAIRFAX PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1144220492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 N FAIRFAX AVE STE 110",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900465363",
            "telephone_number": "323-656-9622",
            "fax_number": "323-656-9718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 N FAIRFAX AVE STE 110",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900465363",
            "telephone_number": "323-656-9622",
            "fax_number": "323-656-9718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BDO CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-28",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "VAYBERMAN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-565-8622"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY41877",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA418770",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1994763",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAIRFAX PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa M. Bateman, MD, FRCPC
• Jackson Bates, DC
• Nisha Batta, MD
• Bruce Baumgarten
• Matthew Hermosura Bautista
• Kenya'Michelle Beavers
• Matthew Ryan Beckelman, ACNP
• Vanessa Beckett, MD
• Asad Julian Bedran, D.O
• Briana Fabienne Beghi, PA

• Community/Retail Pharmacy in West Hollywood, CA
• Providers in West Hollywood, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.