Provider Demographics
NPI:1538205216
Name:J B FAR INC
Entity type:Organization
Organization Name:J B FAR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, AO
Authorized Official - Prefix:
Authorized Official - First Name:YOUSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-582-6078
Mailing Address - Street 1:2699 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4747
Mailing Address - Country:US
Mailing Address - Phone:323-582-6078
Mailing Address - Fax:323-582-0833
Practice Address - Street 1:2699 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4747
Practice Address - Country:US
Practice Address - Phone:323-582-6078
Practice Address - Fax:323-582-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X
CA517213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51721Medicaid
2144039OtherPK
0569751OtherNCPDP PROVIDER IDENTIFICATION NUMBER