=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013786565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENCINO CENTER PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2023
-----------------------------------------------------
Last Update Date | 12/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16740 VENTURA BLVD
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-290-3834
-----------------------------------------------------
Fax | 818-290-3835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16740 VENTURA BLVD
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-290-3834
-----------------------------------------------------
Fax | 818-290-3835
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | IRINA REZIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-290-3834
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------