Provider Demographics
NPI:1780578005
Name:ANAHEIM COMPOUNDING LLC
Entity type:Organization
Organization Name:ANAHEIM COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAEI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:714-279-1111
Mailing Address - Street 1:500 S ANAHEIM HILLS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4761
Mailing Address - Country:US
Mailing Address - Phone:714-279-1111
Mailing Address - Fax:714-279-1115
Practice Address - Street 1:500 S ANAHEIM HILLS RD STE 100
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4761
Practice Address - Country:US
Practice Address - Phone:714-279-1111
Practice Address - Fax:714-279-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58764OtherPHARMACY PERMIT