Healthcare Provider Details

I. General information

NPI: 1396747614
Provider Name (Legal Business Name): PHARMACY HOMECARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12454 OXNARD ST
NORTH HOLLYWOOD CA
91606-4510
US

IV. Provider business mailing address

12454 OXNARD ST
NORTH HOLLYWOOD CA
91606-4510
US

V. Phone/Fax

Practice location:
  • Phone: 818-755-9081
  • Fax: 818-755-9301
Mailing address:
  • Phone: 818-755-9081
  • Fax: 818-755-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY40753
License Number StateCA

VIII. Authorized Official

Name: ELLA PILDERVASER
Title or Position: CEO
Credential:
Phone: 818-755-9081