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General NPI Number Information
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NPI Number | 1356752877
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Entity Type | Organization
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Legal Business Name | GRAND PHARMACY., INC
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 505 S VIRGIL AVE # 107
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City | LOS ANGELES
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State | CA
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Zip | 90020-1406
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Country | US
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Telephone | 213-380-5100
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Fax | 213-380-5101
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Provider Business Mailing Address
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Address Line | 505 S VIRGIL AVE # 107
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City | LOS ANGELES
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State | CA
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Zip | 90020-1406
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Country | US
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Telephone | 213-380-5100
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Fax | 213-380-5101
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Authorized Official
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Title or Position | CEO
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Name | JOON TAE CHOI
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Credential |
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Telephone | 213-380-5100
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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 | 54623
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License Number State | CA
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