Healthcare Provider Details

I. General information

NPI: 1518215086
Provider Name (Legal Business Name): ENCINO FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16060 VENTURA BLVD UNIT #109
ENCINO CA
91436-2761
US

IV. Provider business mailing address

16060 VENTURA BLVD UNIT #109
ENCINO CA
91436-2761
US

V. Phone/Fax

Practice location:
  • Phone: 818-387-8119
  • Fax: 818-387-8499
Mailing address:
  • Phone: 818-387-8119
  • Fax: 818-387-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. AMIR SHAWN KOHAN
Title or Position: CEO
Credential: PHARM D
Phone: 818-387-8119