MEDICARE: INAE OH

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	183500000X	Pharmacist	73919	CA

General Provider Information

NPI Number	:	1578063194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INAE OH

Provider Business Mailing Address
First Line	:	2717 W OLYMPIC BLVD STE 105
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2642
Country	:	US
Telephone Number	:	213-361-5929
Fax Number	:	213-263-2051

Provider Business Practice Location Address
First Line	:	2717 W OLYMPIC BLVD STE 105
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2642
Country	:	US
Telephone Number	:	213-361-5929
Fax Number	:	213-263-2051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2018

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Directions to “ INAE OH ” Practice Location

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