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General NPI Number Information
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NPI Number | 1447657358
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Entity Type | Organization
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Legal Business Name | OLIVE TREE PHARMACY INC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 14124 FOOTHILL BLVD STE 102
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City | SYLMAR
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State | CA
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Zip | 91342-8053
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Country | US
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Telephone | 818-364-5100
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Fax | 818-364-5102
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Provider Business Mailing Address
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Address Line | 14124 FOOTHILL BLVD STE 102
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City | SYLMAR
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State | CA
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Zip | 91342-8049
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Country | US
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Telephone | 818-364-5100
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Fax | 818-364-5102
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Authorized Official
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Title or Position | OWNER / PIC
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Name | WILLIAM ZEN
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Credential |
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Telephone | 818-364-5100
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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 | PHY52415
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License Number State | CA
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