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General NPI Number Information
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NPI Number | 1174997605
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH PHARMACY
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 2811 S SAN PEDRO ST
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City | LOS ANGELES
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State | CA
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Zip | 90011-2023
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Country | US
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Telephone | 323-432-2131
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Fax | 323-432-2012
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Provider Business Mailing Address
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Address Line | 2070 S CENTRAL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90011-1235
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Country | US
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Telephone | 213-536-4888
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Fax | 213-536-4889
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Authorized Official
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Title or Position | OWNER
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Name | REDDA ALHOUSSAYNI
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Credential | PHARM.D.
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Telephone | 323-432-2131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY53627
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License Number State | CA
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