Organization
OLYMPIA PLAZA PHARMACY INC
Active
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
Update your record
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