Organization
1631 MONTANA AVE PHARMACY, LLC
Active
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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