Healthcare Provider Details

I. General information

NPI: 1982154308
Provider Name (Legal Business Name): VENICE FAMILY - STORE 3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 INGLEWOOD BLVD STE 102
CULVER CITY CA
90230-5896
US

IV. Provider business mailing address

604 ROSE AVE
VENICE CA
90291-2767
US

V. Phone/Fax

Practice location:
  • Phone: 310-664-7757
  • Fax:
Mailing address:
  • Phone: 310-664-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHARON NG
Title or Position: PHARMACY DIRECTOR
Credential:
Phone: 310-664-7735