Healthcare Provider Details

I. General information

NPI: 1780799718
Provider Name (Legal Business Name): OCEAN DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17071 VENTURA BLVD STE 100
ENCINO CA
91316-4130
US

IV. Provider business mailing address

17071 VENTURA BLVD STE 100
ENCINO CA
91316-4130
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-5858
  • Fax: 818-788-0607
Mailing address:
  • Phone: 818-788-5858
  • Fax: 818-788-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY34818
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MAKHANI
Title or Position: MANAGING PHCST
Credential: PHARMD RPH
Phone: 818-788-5858