Healthcare Provider Details

I. General information

NPI: 1740904499
Provider Name (Legal Business Name): GEORGE HENIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16279 PARAMOUNT BLVD
PARAMOUNT CA
90723-5421
US

IV. Provider business mailing address

16279 PARAMOUNT BLVD
PARAMOUNT CA
90723-5421
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-1620
  • Fax: 562-630-1720
Mailing address:
  • Phone: 562-630-1620
  • Fax: 562-630-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: