Healthcare Provider Details

I. General information

NPI: 1699023218
Provider Name (Legal Business Name): S O PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 VAN NUYS BLVD
SHERMAN OAKS CA
91403-2913
US

IV. Provider business mailing address

4520 VAN NUYS BLVD
SHERMAN OAKS CA
91403-2913
US

V. Phone/Fax

Practice location:
  • Phone: 818-990-4500
  • Fax: 818-990-7300
Mailing address:
  • Phone: 818-990-4500
  • Fax: 818-990-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FARZAD FARKHANI
Title or Position: PHARMACIST-IN-CHARGE
Credential:
Phone: 818-990-4500