Healthcare Provider Details

I. General information

NPI: 1669775847
Provider Name (Legal Business Name): ENCINO CARE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 VENTURA BLVD STE 135
ENCINO CA
91436-4490
US

IV. Provider business mailing address

16001 VENTURA BLVD SUITE 135
ENCINO CA
91436-4481
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-9200
  • Fax: 818-789-9209
Mailing address:
  • Phone: 818-789-9200
  • Fax: 818-789-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number50459
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: NIRA HARIRI
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 818-377-9194