| NPI | 1144220492 |
|---|---|
| Doing Business As | FAIRFAX PHARMACY |
| Entity Type | Organization |
| Authorized Contact | GREGORY VAYBERMAN President 323-565-8622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CA PHY41877) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2017-02-27 |