Healthcare Provider Details

I. General information

NPI: 1669779310
Provider Name (Legal Business Name): LG PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 HOLLYWOOD BLVD UNIT A
LOS ANGELES CA
90027
US

IV. Provider business mailing address

5400 HOLLYWOOD BLVD UNIT A
LOS ANGELES CA
90027-3406
US

V. Phone/Fax

Practice location:
  • Phone: 323-664-6664
  • Fax: 866-247-6679
Mailing address:
  • Phone: 323-664-6664
  • Fax: 866-247-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44799
License Number StateCA

VIII. Authorized Official

Name: MR. LEVON GRIGORIAN
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 323-664-6664