MEDICARE: SPAULDING PHARMACY INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY59124	OTHER	CA	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1962403568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPAULDING PHARMACY INC

Provider Business Mailing Address
First Line	:	7722 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6220
Country	:	US
Telephone Number	:	323-656-3663
Fax Number	:	323-656-3668

Provider Business Practice Location Address
First Line	:	7722 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6220
Country	:	US
Telephone Number	:	323-656-3663
Fax Number	:	323-656-3668

Authorized Official
Title or Position	:	PRESIDENT/CEO/SECRETARY/DIR
Name	:	ALEXANDER KONOPOV
Credential	:
Telephone Number	:	323-656-3663

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/01/2024

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Directions to “SPAULDING PHARMACY INC ” Practice Location

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