Healthcare Provider Details

I. General information

NPI: 1952308090
Provider Name (Legal Business Name): LARRY ERESHEFSKY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER WING 55 MAIN FLOOR
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

2671 ASTRAL DR
LOS ANGELES CA
90046-1707
US

V. Phone/Fax

Practice location:
  • Phone: 818-254-1658
  • Fax: 818-545-8048
Mailing address:
  • Phone: 310-415-8131
  • Fax: 323-512-7197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number30285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: