Healthcare Provider Details

I. General information

NPI: 1790237113
Provider Name (Legal Business Name): HEALING COMPOUNDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 VAN NUYS BLVD
SHERMAN OAKS CA
91403-1801
US

IV. Provider business mailing address

4955 VAN NUYS BLVD
SHERMAN OAKS CA
91403-1801
US

V. Phone/Fax

Practice location:
  • Phone: 818-905-0669
  • Fax: 818-905-0016
Mailing address:
  • Phone: 818-905-0669
  • Fax: 818-905-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY43586
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY43586
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHY43586
License Number StateCA

VIII. Authorized Official

Name: DR. BABAK R. KOHANTEB
Title or Position: PRESIDENT / PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 818-905-0669