Healthcare Provider Details

I. General information

NPI: 1083609432
Provider Name (Legal Business Name): SHILOH FAMILY PHARMACY,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5551 HOLLYWOOD BLVD SPACE A
LOS ANGELES CA
90028
US

IV. Provider business mailing address

5551 HOLLYWOOD BLVD SPACE A
LOS ANGELES CA
90028
US

V. Phone/Fax

Practice location:
  • Phone: 323-536-9575
  • Fax: 323-536-9576
Mailing address:
  • Phone: 323-536-9575
  • Fax: 323-536-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY 51776
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 51776
License Number StateCA

VIII. Authorized Official

Name: MRS. DIANA ARONSON
Title or Position: PRESIDENT
Credential:
Phone: 323-536-9575