Provider Demographics
NPI:1083413454
Name:BLEND COMPOUNDING PHARMACY INC
Entity type:Organization
Organization Name:BLEND COMPOUNDING PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZIVAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GABAIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-974-4455
Mailing Address - Street 1:23326 HAWTHORNE BLVD STE 185
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4754
Mailing Address - Country:US
Mailing Address - Phone:310-974-4455
Mailing Address - Fax:
Practice Address - Street 1:23326 HAWTHORNE BLVD STE 185
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4754
Practice Address - Country:US
Practice Address - Phone:310-974-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy