Organization
MICHELLE MINE NA
Active
Other names
Siloam Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE MINE NA (PHARMACIST & OWNER)
(213) 382-0700
Entity
Organization
Contact information
Practice address
2528 W OLYMPIC BLVD, SUITE 102, LOS ANGELES, CA 90006-2922
(213) 382-0700
(213) 480-1442
Mailing address
2528 W OLYMPIC BLVD, SUITE 102, LOS ANGELES, CA 90006-2922
(213) 382-0700
(213) 480-1442
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY43105
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0571667
NCPDP
CA
05
—
PHA431050
—
CA
Enumeration date
01/23/2007
Last updated
12/16/2022
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