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General NPI Number Information
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NPI Number | 1811035801
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Entity Type | Organization
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Legal Business Name | KT PLAZA PHARMACY, INC.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 928 S WESTERN AVE STE 110
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City | LOS ANGELES
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State | CA
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Zip | 90006-1000
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Country | US
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Telephone | 213-382-0212
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Fax | 213-382-0812
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Provider Business Mailing Address
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Address Line | 928 S WESTERN AVE STE 110
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City | LOS ANGELES
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State | CA
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Zip | 90006-1000
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Country | US
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Telephone | 213-382-0212
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Fax | 213-382-0812
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Authorized Official
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Title or Position | PHARAMCIST/PIC
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Name | JAMIE PARK
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Credential |
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Telephone | 213-382-0212
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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 | 54469
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License Number State | CA
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