MEDICARE: PHARMACY HOMECARE NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHY40753	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396747614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY HOMECARE NETWORK

Provider Business Mailing Address
First Line	:	12454 OXNARD ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4510
Country	:	US
Telephone Number	:	818-755-9081
Fax Number	:	818-755-9301

Provider Business Practice Location Address
First Line	:	12454 OXNARD ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4510
Country	:	US
Telephone Number	:	818-755-9081
Fax Number	:	818-755-9301

Authorized Official
Title or Position	:	CEO
Name	:	ELLA PILDERVASER
Credential	:
Telephone Number	:	818-755-9081

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/22/2020

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Directions to “PHARMACY HOMECARE NETWORK ” Practice Location

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