Healthcare Provider Details

I. General information

NPI: 1356879787
Provider Name (Legal Business Name): COSMED PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6521 VAN NUYS BLVD
VAN NUYS CA
91401-1425
US

IV. Provider business mailing address

6521 VAN NUYS BLVD
VAN NUYS CA
91401-1425
US

V. Phone/Fax

Practice location:
  • Phone: 818-933-2010
  • Fax: 818-933-2018
Mailing address:
  • Phone: 818-933-2010
  • Fax: 818-933-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number55488
License Number StateCA

VIII. Authorized Official

Name: KHANH-LONG THAI
Title or Position: CEO
Credential: PHARM D
Phone: 818-933-2010