Organization
GRAND VENICE LLC
Active
Other names
WILSHIRE GRAND PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATAYOUN K BARKHORBAR PHARM D (MEMBER/RPH)
(213) 480-1300
Entity
Organization
Contact information
Practice address
2974 WILSHIRE BLVD, LOS ANGELES, CA 90010-1101
(213) 480-1300
(213) 480-1301
Mailing address
2974 WILSHIRE BLVD, LOS ANGELES, CA 90010-1101
(213) 480-1300
(213) 480-1301
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY54082
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56-58426
NCPDP PROVIDER
CA
01
—
PHY54082
BOARD OF PHARMACY RETAIL PERMIT
CA
Enumeration date
01/05/2016
Last updated
03/21/2016
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