Active NPI
Dorado Pharmacy Inc
- Community/Retail Pharmacy
- Pacoima, CA
National Provider Identifier
1639545304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY53685
- Legal business name
- DORADO PHARMACY INC
- Doing business as
- Dorado Pharmacy
- Practice address
- 13003 Van Nuys Blvd Ste E
Pacoima, CA 91331-8324 - Phone
- (818) 485-5554
- Fax
- (818) 485-5560
- NPI assigned
- Aug 18, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Razan Darrouj
- Title
- Owner
- Phone
- (818) 485-5554
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHY53685 | CA | Primary |
Addresses
Primary practice location
13003 Van Nuys Blvd Ste E
Pacoima, CA 91331-8324
Mailing address
13003 Van Nuys Blvd
Unit #E
Pacoima, CA 91331-8316
Phone (818) 485-5554
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639545304 | Medicaid | CA |
Other names 1
- Dorado Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180306002240 | CA | DME Supplier - Pharmacy | 7315208485 | Practice locations: Pacoima, CA |
| O20210805001620 | CA | Part B Supplier - Pharmacy | 7315208485 |
2 other NPIs on this enrollment Practice locations: Pacoima, CA |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
13003 Van Nuys Blvd
Ste E
Pacoima, CA 91331
Phone (818) 485-5554
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439856000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1625961600000",
"number": "1639545304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13003 VAN NUYS BLVD",
"address_2": "UNIT #E",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913318316",
"telephone_number": "818-485-5554",
"fax_number": "818-485-5560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13003 VAN NUYS BLVD STE E",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913318324",
"telephone_number": "818-485-5554",
"fax_number": "818-485-5560"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DORADO PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2015-08-18",
"last_updated": "2021-07-11",
"certification_date": "2021-07-11",
"status": "A",
"authorized_official_last_name": "DARROUJ",
"authorized_official_first_name": "RAZAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "818-485-5554"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "PHY53685",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1639545304",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Dorado Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Dorado Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pacoima, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.