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General NPI Number Information
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NPI Number | 1215479027
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Entity Type | Organization
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Legal Business Name | GARDENA PHARMACY CORPORATION
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 15418 CRENSHAW BLVD
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City | GARDENA
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State | CA
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Zip | 90249-4524
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Country | US
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Telephone | 424-329-3904
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Fax | 424-329-3905
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Provider Business Mailing Address
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Address Line | 15418 CRENSHAW BLVD
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City | GARDENA
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State | CA
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Zip | 90249-4524
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Country | US
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Telephone | 424-329-3904
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Fax | 424-329-3905
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Authorized Official
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Title or Position | PRESIDENT / PHARMACIST IN CHARGE
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Name | MR. LINH M. LE
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Credential | PHARM D
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Telephone | 424-329-3904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY 55290
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License Number State | CA
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