MEDICARE: SHILOH FAMILY PHARMACY,INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHY 51776	CA
2	3336C0003X	Community/Retail Pharmacy	PHY 51776	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY 51776	OTHER	CA	CALIFORNIA STATE BOARD OF PHARMACY PERMIT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	05-52112	OTHER	CA	NCPDP NUMBER
4	1083609432	OTHER	CA	NPI

NPI Number	:	1083609432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHILOH FAMILY PHARMACY,INC.

Provider Business Mailing Address
First Line	:	5551 HOLLYWOOD BLVD
Second Line	:	SPACE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90028
Country	:	US
Telephone Number	:	323-536-9575
Fax Number	:	323-536-9576

Provider Business Practice Location Address
First Line	:	5551 HOLLYWOOD BLVD
Second Line	:	SPACE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90028
Country	:	US
Telephone Number	:	323-536-9575
Fax Number	:	323-536-9576

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DIANA ARONSON
Credential	:
Telephone Number	:	323-536-9575

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	04/27/2017

1625 SCHRADER BLVD
LOS ANGELES, CA
90028-6213

Practice Phone: 323-993-7500
Practice Fax:

1625 SCHRADER BLVD , FL 3
LOS ANGELES, CA
90028-6213

Practice Phone: 323-993-7532
Practice Fax: 323-308-4447

1625 SCHRADER BLVD , 3RD FLOOR
LOS ANGELES, CA
90028-6213