Provider Demographics
NPI:1447290192
Name:FAMILY PHARMACY OF BEVERLY HILLS INC
Entity type:Organization
Organization Name:FAMILY PHARMACY OF BEVERLY HILLS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PIC
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-653-4070
Mailing Address - Street 1:8314 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2304
Mailing Address - Country:US
Mailing Address - Phone:323-653-4070
Mailing Address - Fax:323-653-4079
Practice Address - Street 1:8314 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2304
Practice Address - Country:US
Practice Address - Phone:323-653-4070
Practice Address - Fax:323-653-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY393493336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066745OtherPK
CAPHA393490Medicaid
0539049OtherNCPDP PROVIDER IDENTIFICATION NUMBER