Organization
SJS RX
Active
Other names
Garden Plaza Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MITRA RASTEGAR PHARMD (CEO)
(818) 345-7982
Entity
Organization
Contact information
Practice address
18411 CLARK ST STE 106, TARZANA, CA 91356-3529
(818) 345-7982
(818) 345-7983
Mailing address
18411 CLARK ST STE 106, TARZANA, CA 91356-3529
(818) 345-7982
(818) 345-7983
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1993092
PK
—
05
—
PHA57452
—
CA
Enumeration date
10/20/2006
Last updated
03/22/2022
Update your record
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