PV Drug Store

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY54543 Issued in CA

Legal business name

PV DRUG STORE

Doing business as

PV Drug Store

Practice address

2325 Palos Verdes Dr W Ste 220
Palos Verdes Estates, CA 90274-2777

Phone

(424) 327-2990

Fax

(424) 327-2996

NPI assigned

Jul 27, 2016

Organization subpart

No

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

Authorized official

Name

Vahid Bordbar, PHARM.DNPI 1861845273

Title

Owner, Pic, Ao

Phone

(310) 462-1310

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• PV Drug Store Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vahid Bordbar

  • Pharmacotherapy Pharmacist
  • Palos Verdes Estates, CA
  • NPI 1861845273
  NPD Authorized official

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

{
    "created_epoch": "1469577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1790238681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 PALOS VERDES DR W STE 220",
            "city": "PALOS VERDES ESTATES",
            "state": "CA",
            "postal_code": "902742777",
            "telephone_number": "424-327-2990",
            "fax_number": "424-327-2996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 PALOS VERDES DR W STE 220",
            "city": "PALOS VERDES ESTATES",
            "state": "CA",
            "postal_code": "902742777",
            "telephone_number": "424-327-2990",
            "fax_number": "424-327-2996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PV DRUG STORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-27",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "BORDBAR",
        "authorized_official_first_name": "VAHID",
        "authorized_official_title_or_position": "OWNER, PIC, AO",
        "authorized_official_telephone_number": "310-462-1310",
        "authorized_official_credential": "PHARM.D"
    },
    "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": "PHY54543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2162223",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PV Drug Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeanette Peter, CRNA
• Philip Gruskin MD Inc
• Michelle Pock, OTR/L
• Jo-Ann Portanova
• Sarah Putt, OT
• Pve Manor, Inc.
• Elaine Marie Quintiliani, LMFT
• Raj a. Mittal, M.D., a Medical Corporation
• Ralphs Grocery Company (Ralphs Pharmacy)
• Rachel Hannako Rangwala, M.D.

• Community/Retail Pharmacy in Palos Verdes Estates, CA
• Providers in Palos Verdes Estates, 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 Jul 19, 2018; 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.