Organization
BRAVO PHARMACY LLC
Active
Other names
Bravo Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SANG KIM (CEO)
(310) 618-1988
Entity
Organization
Contact information
Practice address
10211 AVALON BLVD, LOS ANGELES, CA 90003-4819
(323) 757-2727
(323) 575-2722
Mailing address
2275 TORRANCE BLVD, SUITE101, TORRANCE, CA 90501-2550
(310) 618-1988
(310) 618-1996
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY49276
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5632422
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/30/2008
Last updated
11/15/2011
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