Provider Demographics
NPI:1396996062
Name:KHAIMOV, ARKADIY ERIC
Entity type:Individual
Prefix:
First Name:ARKADIY
Middle Name:ERIC
Last Name:KHAIMOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21850 YBARRA RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4235
Mailing Address - Country:US
Mailing Address - Phone:323-363-7250
Mailing Address - Fax:
Practice Address - Street 1:7900 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-3304
Practice Address - Country:US
Practice Address - Phone:323-876-4466
Practice Address - Fax:323-876-0635
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 51410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist