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General NPI Number Information
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NPI Number | 1417346305
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Entity Type | Organization
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Legal Business Name | CRENSHAW PHARMACY INC
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 3631 CRENSHAW BLVD STE 111
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City | LOS ANGELES
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State | CA
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Zip | 90016-4869
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Country | US
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Telephone | 323-732-5555
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Fax | 323-734-5555
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Provider Business Mailing Address
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Address Line | 3631 CRENSHAW BLVD STE 111
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City | LOS ANGELES
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State | CA
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Zip | 90016-4869
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Country | US
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Telephone | 323-732-5555
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Fax | 323-734-5555
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Authorized Official
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Title or Position | CEO
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Name | DR. ARDALAN BEHEL
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Credential | RPH
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Telephone | 310-402-7318
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 54248
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY55990
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License Number State | CA
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