Provider Demographics
NPI:1366940827
Name:KEVIN A ATTAIE PHARMACEUTICAL, INC
Entity type:Organization
Organization Name:KEVIN A ATTAIE PHARMACEUTICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ABBAS
Authorized Official - Last Name:ATTAIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:805-267-7139
Mailing Address - Street 1:2945 TOWNSGATE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5866
Mailing Address - Country:US
Mailing Address - Phone:805-261-1544
Mailing Address - Fax:805-230-2224
Practice Address - Street 1:2945 TOWNSGATE RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-267-7139
Practice Address - Fax:805-230-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65216333600000X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy