MEDICARE: PHARMACY HOME INFUSION NETWORK

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	3336H0001X	Home Infusion Therapy Pharmacy

General Provider Information

NPI Number	:	1447897921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY HOME INFUSION NETWORK

Provider Business Mailing Address
First Line	:	900 W GLENOAKS BLVD STE G
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2664
Country	:	US
Telephone Number	:	818-294-2657
Fax Number	:	661-310-3848

Provider Business Practice Location Address
First Line	:	900 W GLENOAKS BLVD STE G
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2664
Country	:	US
Telephone Number	:	818-294-2657
Fax Number	:	661-310-3848

Authorized Official
Title or Position	:	ADMIN
Name	:	GINGER JOHNSON
Credential	:
Telephone Number	:	818-294-2657

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	12/06/2019

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