Healthcare Provider Details

I. General information

NPI: 1912233644
Provider Name (Legal Business Name): BRAVO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7316 COMPTON AVE
LOS ANGELES CA
90001-2532
US

IV. Provider business mailing address

7316 COMPTON AVE
LOS ANGELES CA
90001-2532
US

V. Phone/Fax

Practice location:
  • Phone: 323-586-9828
  • Fax: 323-589-2174
Mailing address:
  • Phone: 323-586-9828
  • Fax: 323-589-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 53315
License Number StateCA

VIII. Authorized Official

Name: MR. FRED K CHO
Title or Position: MEMBER/PIC
Credential: RPH
Phone: 323-586-9828