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General NPI Number Information
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NPI Number | 1871764134
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Entity Type | Organization
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Legal Business Name | PALISADES COMPOUNDING PHARMACY INC
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 540 PALISADES DR
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-2844
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Country | US
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Telephone | 310-454-4848
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Fax | 310-454-3838
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Provider Business Mailing Address
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Address Line | 540 PALISADES DR
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-2844
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Country | US
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Telephone | 310-454-4848
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Fax | 310-454-3838
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | SHAHRAM SOROUDI
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Credential |
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Telephone | 310-777-2000
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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 | 48986
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License Number State | CA
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