Organization
COMPOUNDING PHARMACY ASSOCIATES AND CONSULTANTS INC
Active
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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