Healthcare Provider Details

I. General information

NPI: 1881709814
Provider Name (Legal Business Name): PRM PHARMACEUTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11126 PALMS BLVD
LOS ANGELES CA
90034-6503
US

IV. Provider business mailing address

11126 PALMS BLVD
LOS ANGELES CA
90034-6503
US

V. Phone/Fax

Practice location:
  • Phone: 310-837-1030
  • Fax: 310-837-9946
Mailing address:
  • Phone: 310-837-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 44725
License Number StateCA

VIII. Authorized Official

Name: DR. EDMOND NIKRAVESH
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 310-837-1030