Organization
GARDENA CENTER PHARMACY LLC
Active
Other names
GARDENA CENTER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BO PARK (PHARMACIST AND OWNER)
(310) 767-1522
Entity
Organization
Contact information
Practice address
15407 S WESTERN AVE, GARDENA, CA 90249-4318
(310) 767-1522
(310) 767-1174
Mailing address
15407 S WESTERN AVE, GARDENA, CA 90249-4318
(310) 767-1522
(310) 767-1174
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY41295
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1996114
PK
—
05
—
PHA412950
—
CA
Enumeration date
01/08/2007
Last updated
11/09/2015
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