Organization
PROVIDENCE HEALTH SYSTEM-SOUTHERN CALIFORNIA
Active
Other names
Providence Tarzana Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
(425) 525-5392
Entity
Organization
Contact information
Practice address
18370 BURBANK BLVD STE 104, TARZANA, CA 91356-2804
(818) 996-3600
(818) 996-8630
Mailing address
PO BOX 3268, PORTLAND, OR 97208-3268
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
04/30/2020
Last updated
04/30/2020
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