Organization
TRICARE PHARMACY
Active
Other names
Pharmacy Service Enterprises Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK HOWARD DEUTSCH (OWNER)
(818) 985-1814
Entity
Organization
Contact information
Practice address
13237 SATICOY ST, SUITE 4, NORTH HOLLYWOOD, CA 91605
(818) 985-1814
Mailing address
13237 SATICOY ST, SUITE 4, NORTH HOLLYWOOD, CA 91605-3432
(818) 985-1814
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHY46616
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHA349270
MEDICAL PROVIDER NUMBER
—
Enumeration date
05/28/2008
Last updated
05/28/2008
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