MEDICARE: ECHO 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	PHY40631	CA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0519112	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467506808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECHO PARK PHARMACY

Provider Business Mailing Address
First Line	:	1310 ECHO PARK AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 ECHO PARK AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3318
Country	:	US
Telephone Number	:	213-482-1149
Fax Number	:	213-482-5100

Authorized Official
Title or Position	:	OWNER
Name	:	TAREK EBRAHIM
Credential	:
Telephone Number	:	818-395-6691

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	09/11/2025

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Directions to “ECHO PARK PHARMACY ” Practice Location

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