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General NPI Number Information
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NPI Number | 1619036043
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Entity Type | Organization
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Legal Business Name | EMERSON PHARMACY INC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 8610 S SEPULVEDA BLVD STE 108
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City | LOS ANGELES
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State | CA
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Zip | 90045-4009
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Country | US
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Telephone | 310-670-3834
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Fax | 310-670-4921
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Provider Business Mailing Address
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Address Line | 1702 S ROBERTSON BLVD # 152
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City | LOS ANGELES
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State | CA
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Zip | 90035-4316
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Country | US
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Telephone | 310-670-3834
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Fax | 310-670-4921
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Authorized Official
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Title or Position | PRESIDENT
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Name | NIMA RODEFSHALOM
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Credential |
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Telephone | 310-670-3834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY53692
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License Number State | CA
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