Provider Demographics
NPI:1114217239
Name:CCRX INC
Entity type:Organization
Organization Name:CCRX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:SOHEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFARMEHR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:213-674-7577
Mailing Address - Street 1:1919 W 7TH ST UNIT M
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4103
Mailing Address - Country:US
Mailing Address - Phone:213-674-7577
Mailing Address - Fax:213-674-7799
Practice Address - Street 1:1919 W 7TH ST UNIT M
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-674-7577
Practice Address - Fax:213-674-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY561493336C0003X
CAPHY508033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56-40710OtherNCPDP PROVIDER NUMBER
CA56149OtherSTATE BOARD OF PHARMACY PERMIT
CA1114217239Medicaid