MEDICARE: COUNTY OF LOS ANGELES

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
2	3336I0012X	Institutional Pharmacy	HPE32796	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0519578	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1629011986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF LOS ANGELES

Provider Business Mailing Address
First Line	:	14445 OLIVE VIEW DR
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-1437
Country	:	US
Telephone Number	:	818-364-3059
Fax Number	:	818-364-3381

Provider Business Practice Location Address
First Line	:	14445 OLIVE VIEW DR
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-1437
Country	:	US
Telephone Number	:	818-364-3059
Fax Number	:	818-364-3381

Authorized Official
Title or Position	:	PHARMACY SVS CHIEF III
Name	:	STEVE LEE
Credential	:	PHARM. D.
Telephone Number	:	818-364-3059

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/16/2012

Similar Medicare Providers

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Practice Location Address:

14445 OLIVE VIEW DR
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91342-1437

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Practice Fax:

1598758864 — MIGUEL ANGEL VALDES-SUEIRAS MD
Practice Location Address:

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Practice Fax:

1225003072 — INSIGHT HEALTH CORP
Practice Location Address:

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1336195890 — DAVIN ANTHONY AGUSTINES DO
Practice Location Address:

14445 OLIVE VIEW DR , ROOM 6D129
SYLMAR, CA
91342-1437

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1134165467 — DR. STANLEY KWAN DEA M.D.
Practice Location Address:

14445 OLIVE VIEW DR , ROOM 2B-182
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1467480251 — DR. HEATHERLY SMITH VANDEWEGHE M.D.
Practice Location Address:

14445 OLIVE VIEW DR , DEPARTMENT OF PEDIATRICS
SYLMAR, CA
91342-1437

Practice Phone: 818-364-3233
Practice Fax: 818-364-3243

Directions to “COUNTY OF LOS ANGELES ” Practice Location

Language	Start Address	Practice Location

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