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General NPI Number Information
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NPI Number | 1245338276
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Entity Type | Organization
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Legal Business Name | BEVERLY GLEN PHARMACY INC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 2946 N BEVERLY GLEN CIR
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City | LOS ANGELES
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State | CA
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Zip | 90077-1724
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Country | US
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Telephone | 310-475-0568
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Fax | 310-475-5478
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Provider Business Mailing Address
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Address Line | 2946 N BEVERLY GLEN CIR
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City | LOS ANGELES
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State | CA
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Zip | 90077-1724
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Country | US
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Telephone | 310-475-0568
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Fax | 310-475-5478
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADAM MICHAEL BURMAN
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Credential |
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Telephone | 310-475-0568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | PHY55866
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License Number State | CA
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