Healthcare Provider Details

I. General information

NPI: 1013136043
Provider Name (Legal Business Name): CAMDEN PHARMACY OF BEVERLY HILLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N CAMDEN DR
BEVERLY HILLS CA
90210-4532
US

IV. Provider business mailing address

414 N CAMDEN DR
BEVERLY HILLS CA
90210-4532
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-3363
  • Fax:
Mailing address:
  • Phone: 310-273-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47557
License Number StateCA

VIII. Authorized Official

Name: MR. JEFFREY GROSS
Title or Position: OWNER
Credential:
Phone: 310-273-3363