Healthcare Provider Details

I. General information

NPI: 1295589190
Provider Name (Legal Business Name): VICTOR OHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 W GLENOAKS BLVD
GLENDALE CA
91202-2133
US

IV. Provider business mailing address

2011 S PRIMROSE AVE
ALHAMBRA CA
91803-2937
US

V. Phone/Fax

Practice location:
  • Phone: 818-600-0777
  • Fax:
Mailing address:
  • Phone: 209-244-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: