Organization
COMPOUNDING PHARMACY ASSOCIATES AND CONSULTANTS INC
Active
Other names
Portola Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GENEVA GE CHEN PHARM D PHD (PRESIDENT)
(323) 222-2362
Entity
Organization
Contact information
Practice address
3408 N EASTERN AVE, LOS ANGELES, CA 90032-1934
(323) 222-2362
(323) 225-4171
Mailing address
3408 N EASTERN AVE, LOS ANGELES, CA 90032-1934
(323) 222-2362
(323) 225-4171
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY55260
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-10760
NCPDP NUMBER
CA
05
—
1275669020
—
CA
01
—
PHY55260
CALIFORNIA STATE BOARD OF PHARMACY PERMIT
CA
Enumeration date
02/26/2007
Last updated
03/11/2021
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