Healthcare Provider Details

I. General information

NPI: 1922915628
Provider Name (Legal Business Name): LA COUNTY PROBATION DEPARTMENT MEDICAL DIVISION PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 EASTLAKE AVE
LOS ANGELES CA
90033-1009
US

IV. Provider business mailing address

1605 EASTLAKE AVE
LOS ANGELES CA
90033-1009
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-8801
  • Fax:
Mailing address:
  • Phone: 323-226-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN HENDERSON
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 213-893-5304