Healthcare Provider Details

I. General information

NPI: 1740654045
Provider Name (Legal Business Name): PHARMACIST AT HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 ROSECRANS AVE STE P2
PARAMOUNT CA
90723
US

IV. Provider business mailing address

7922 ROSECRANS AVE STE P2
PARAMOUNT CA
90723-6028
US

V. Phone/Fax

Practice location:
  • Phone: 310-749-7078
  • Fax:
Mailing address:
  • Phone: 310-749-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number46153
License Number StateCA

VIII. Authorized Official

Name: WILLIAM W FOBI SR.
Title or Position: PRESIDENT
Credential: PHARM.D
Phone: 310-749-7078