Healthcare Provider Details

I. General information

NPI: 1083134662
Provider Name (Legal Business Name): STEVEN VAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROBERTSON BLVD STE 601
BEVERLY HILLS CA
90211-1793
US

IV. Provider business mailing address

11875 EXLINE ST APT E
EL MONTE CA
91732-2672
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3534
  • Fax:
Mailing address:
  • Phone: 626-679-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number75388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: