Organization
OLYMPIA PLAZA PHARMACY INC
Active
Other names
OLYMPIA PLAZA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TATYANA BOROKHOVICH RPH (PIC)
(323) 937-2590
Entity
Organization
Contact information
Practice address
5901 W OLYMPIC BLVD, SUITE 103, LOS ANGELES, CA 90036-4667
(323) 937-2590
(323) 937-0259
Mailing address
5901 W OLYMPIC BLVD, SUITE 103, LOS ANGELES, CA 90036-4667
(323) 937-2590
(323) 937-0259
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY48416
CA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
PHY 48416
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0597902
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
1477615003
—
CA
Enumeration date
12/13/2006
Last updated
09/04/2012
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