MEDICARE: OCEAN PARK PHARMACY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY30898	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2005002	OTHER		PK

General Provider Information

NPI Number	:	1366453854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN PARK PHARMACY

Provider Business Mailing Address
First Line	:	2731 OCEAN PARK BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5205
Country	:	US
Telephone Number	:	310-452-5705
Fax Number	:	310-452-2508

Provider Business Practice Location Address
First Line	:	2731 OCEAN PARK BLVD
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5205
Country	:	US
Telephone Number	:	310-452-5705
Fax Number	:	310-452-2508

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT ROSEN
Credential	:
Telephone Number	:	310-452-5705

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	01/18/2017

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Directions to “OCEAN PARK PHARMACY ” Practice Location

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