Organization
BNHA HEALTH GROUP INC
Active
Other names
SAINT JOHNS PLAZA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NILESH KOTADIYA (CFO/DIRECTOR)
(310) 453-6553
Entity
Organization
Contact information
Practice address
1301 20TH ST, STE 120, SANTA MONICA, CA 90404-2094
(310) 453-6553
(310) 828-5645
Mailing address
1301 20TH ST, STE 120, SANTA MONICA, CA 90404-2094
(310) 453-6553
(310) 828-5645
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY57666
PHARMACY BOP LICENSE
CA
Enumeration date
11/30/2005
Last updated
03/12/2020
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