Healthcare Provider Details

I. General information

NPI: 1912087537
Provider Name (Legal Business Name): STEPHAN LEO FLASCHA R.PH. -PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 WILSHIRE BLVD US DEPT OF VETERANS AFFAIRS GLA HEALTHCARE SYSTEM
LOS ANGELES CA
90073
US

IV. Provider business mailing address

2100 S CANFIELD AVE
LOS ANGELES CA
90034-1113
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone: 310-202-1074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37472
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number37472
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number37472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: