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General NPI Number Information
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NPI Number | 1225849995
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Entity Type | Organization
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Legal Business Name | SHALOM RX INC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1082 N WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029
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Country | US
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Telephone | 323-450-9777
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Fax | 323-450-9555
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Provider Business Mailing Address
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Address Line | 1082 N WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029
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Country | US
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Telephone | 323-450-9777
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Fax | 323-450-9555
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | BABAK KOHANCHI
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Credential | PHARM D
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Telephone | 323-450-9777
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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 |
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License Number State |
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