Organization
1631 MONTANA AVE PHARMACY, LLC
Active
Other names
REGENT SQUARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELEANOR KONG PHARMD (PHARMACIST IN CHARGE)
(310) 393-0761
Entity
Organization
Contact information
Practice address
1631 MONTANA AVE, SANTA MONICA, CA 90403-1807
(310) 393-0761
(310) 395-6654
Mailing address
1631 MONTANA AVE, SANTA MONICA, CA 90403-1807
(310) 393-0761
(310) 395-6654
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY 49018
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-73065
NCPDP
CA
05
—
PHA465390
—
CA
Enumeration date
08/01/2006
Last updated
04/14/2008
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