Pharmacy 90210 Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

51013 Issued in CA

Legal business name

PHARMACY 90210 INC

Practice address

9735 Wilshire Blvd
Suite 110
Beverly Hills, CA 90212-2107

Phone

(310) 777-2000

Fax

(310) 777-2001

NPI assigned

Jul 24, 2012

Organization subpart

No

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

Authorized official

Name

Shahram Soroudi

Title

President, Ceo, Pic

Phone

(310) 777-2000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PHARMACY 90210 Doing business as

Locations

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1265788558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9735 WILSHIRE BLVD",
            "address_2": "SUITE 110",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902122107",
            "telephone_number": "310-777-2000",
            "fax_number": "310-777-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9735 WILSHIRE BLVD",
            "address_2": "SUITE 110",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902122107",
            "telephone_number": "310-777-2000",
            "fax_number": "310-777-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACY 90210 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-24",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "SOROUDI",
        "authorized_official_first_name": "SHAHRAM",
        "authorized_official_title_or_position": "PRESIDENT, CEO, PIC",
        "authorized_official_telephone_number": "310-777-2000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "51013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136188",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHARMACY 90210",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Beverly Hills, CA
• Providers in Beverly Hills, 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 Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.