Healthcare Provider Details

I. General information

NPI: 1073361093
Provider Name (Legal Business Name): LA PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 WESTWOOD BLVD
LOS ANGELES CA
90025-4612
US

IV. Provider business mailing address

11961 MONTANA AVE APT 204
LOS ANGELES CA
90049-5000
US

V. Phone/Fax

Practice location:
  • Phone: 310-475-6000
  • Fax:
Mailing address:
  • Phone: 818-632-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NIMA KOHANGHADOSH
Title or Position: CEO
Credential:
Phone: 818-632-4686