=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245537810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPRESS PHARMACY SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2011
-----------------------------------------------------
Last Update Date | 07/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1711 W TEMPLE ST STE 100B
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90026-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-674-2520
-----------------------------------------------------
Fax | 213-674-2305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1711 W TEMPLE ST SUITE 100B
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90026-5421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-674-2250
-----------------------------------------------------
Fax | 213-674-3229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PIC
-----------------------------------------------------
Name | BORIS GRINSHTEYN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-674-2250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | 51608
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------