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General NPI Number Information
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NPI Number | 1285789248
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Entity Type | Organization
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Legal Business Name | MICHELLE MINE NA
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 2528 W OLYMPIC BLVD SUITE 102
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City | LOS ANGELES
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State | CA
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Zip | 90006-2922
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Country | US
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Telephone | 213-382-0700
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Fax | 213-480-1442
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Provider Business Mailing Address
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Address Line | 2528 W OLYMPIC BLVD SUITE 102
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City | LOS ANGELES
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State | CA
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Zip | 90006-2922
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Country | US
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Telephone | 213-382-0700
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Fax | 213-480-1442
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Authorized Official
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Title or Position | PHARMACIST & OWNER
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Name | MRS. MICHELLE MINE NA
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Credential |
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Telephone | 213-382-0700
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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 | PHY43105
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License Number State | CA
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