Healthcare Provider Details

I. General information

NPI: 1225440720
Provider Name (Legal Business Name): MAKSIM OLSHANSKY PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S LA BREA AVE
LOS ANGELES CA
90036-3023
US

IV. Provider business mailing address

260 S LA BREA AVE
LOS ANGELES CA
90036-3023
US

V. Phone/Fax

Practice location:
  • Phone: 323-937-9383
  • Fax: 323-937-9916
Mailing address:
  • Phone: 323-937-9383
  • Fax: 323-937-9916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number65932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: