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Organization

ECHO PARK PHARMACY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TAREK EBRAHIM (OWNER)
(818) 395-6691
Entity
Organization

Contact information

Practice address
1310 ECHO PARK AVE, LOS ANGELES, CA 90026-3318
(213) 482-1149
(213) 482-5100
Mailing address
1310 ECHO PARK AVE, LOS ANGELES, CA 90026-3318

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY40631
CA
3336C0003X
Community/Retail Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0519112
OTHER ID NUMBER-COMMERCIAL NUMBER
05
PHA406310
CA
Enumeration date
01/23/2007
Last updated
09/11/2025
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  • Eligibility checks
  • EDI platform