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General NPI Number Information
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NPI Number | 1467506808
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Entity Type | Organization
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Legal Business Name | ECHO PARK PHARMACY
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1310 ECHO PARK AVE
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City | LOS ANGELES
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State | CA
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Zip | 90026-3318
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Country | US
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Telephone | 213-482-1149
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Fax | 213-482-5100
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Provider Business Mailing Address
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Address Line | 1310 ECHO PARK AVE
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City | LOS ANGELES
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State | CA
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Zip | 90026-3318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAREK EBRAHIM
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Credential |
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Telephone | 818-395-6691
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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 | PHY40631
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License Number State | CA
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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 |
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License Number State |
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