Healthcare Provider Details

I. General information

NPI: 1093875577
Provider Name (Legal Business Name): LOS ANGELES DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 W OLYMPIC BLVD SUITE 118
LOS ANGELES CA
90006-6501
US

IV. Provider business mailing address

3030 WEST OLYMPIC BLVD SUITE 118
LOS ANGELES CA
90006
US

V. Phone/Fax

Practice location:
  • Phone: 213-387-3030
  • Fax: 213-739-2020
Mailing address:
  • Phone: 213-387-3030
  • Fax: 213-739-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY43829
License Number StateCA

VIII. Authorized Official

Name: JAY IM
Title or Position: OWNER
Credential:
Phone: 213-387-3030