Healthcare Provider Details

I. General information

NPI: 1144203167
Provider Name (Legal Business Name): PHARMACY OF THE STARS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 AVENUE OF THE STARS SUITE A105
LOS ANGELES CA
90067-4301
US

IV. Provider business mailing address

1900 AVENUE OF THE STARS SUITE A105
LOS ANGELES CA
90067-4301
US

V. Phone/Fax

Practice location:
  • Phone: 310-556-4682
  • Fax: 310-556-4683
Mailing address:
  • Phone: 310-556-4682
  • Fax: 310-556-4683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46038
License Number StateCA

VIII. Authorized Official

Name: MS. HYUN S PARK
Title or Position: PHARMACIST
Credential: RPH
Phone: 310-556-4682