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General NPI Number Information
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NPI Number | 1295162162
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Entity Type | Organization
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Legal Business Name | ENTRACELL PHARMACY INC.
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 10435 SANTA MONICA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-6936
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Country | US
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Telephone | 800-299-9047
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Fax | 800-677-6079
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Provider Business Mailing Address
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Address Line | 10435 SANTA MONICA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-6936
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Country | US
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Telephone | 800-299-9047
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Fax | 800-677-6079
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Authorized Official
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Title or Position | CEO / PRESIDENT
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Name | MR. KAMBIZ YADIDI
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Credential |
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Telephone | 800-299-9047
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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 | PHY51760
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License Number State | CA
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