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General NPI Number Information
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NPI Number | 1265617823
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Entity Type | Organization
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Legal Business Name | GRANCELL VILLAGE OF THE LOS ANGELES
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 7150 TAMPA AVE 1ST FLOOR
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City | RESEDA
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State | CA
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Zip | 91335
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Country | US
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Telephone | 818-758-5017
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Fax | 818-774-2430
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Provider Business Mailing Address
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Address Line | 7150 TAMPA AVE 1ST FLOOR
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City | RESEDA
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State | CA
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Zip | 91335-3700
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Country | US
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Telephone | 818-758-5017
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Fax | 818-774-2430
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY SERVICES
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Name | BOB SHMAEFF
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Credential | MPA
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Telephone | 818-654-5521
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | MSP48566
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License Number State | CA
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