Provider Demographics
NPI:1861570376
Name:BRENT-AIR PHARMACY INC
Entity type:Organization
Organization Name:BRENT-AIR PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO AND PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-476-2211
Mailing Address - Street 1:134 S BARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3309
Mailing Address - Country:US
Mailing Address - Phone:310-476-2211
Mailing Address - Fax:310-472-8659
Practice Address - Street 1:134 S BARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3309
Practice Address - Country:US
Practice Address - Phone:310-476-2211
Practice Address - Fax:310-472-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY486163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992063OtherPK