Provider Demographics
NPI:1083609432
Name:SHILOH FAMILY PHARMACY,INC.
Entity Type:Organization
Organization Name:SHILOH FAMILY PHARMACY,INC.
Other - Org Name:SHILOH FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-536-9575
Mailing Address - Street 1:5551 HOLLYWOOD BLVD
Mailing Address - Street 2:SPACE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028
Mailing Address - Country:US
Mailing Address - Phone:323-536-9575
Mailing Address - Fax:323-536-9576
Practice Address - Street 1:5551 HOLLYWOOD BLVD
Practice Address - Street 2:SPACE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028
Practice Address - Country:US
Practice Address - Phone:323-536-9575
Practice Address - Fax:323-536-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 51776333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 51776OtherCALIFORNIA STATE BOARD OF PHARMACY PERMIT
CA1083609432Medicaid
CA05-52112OtherNCPDP NUMBER
CA1083609432OtherNPI
CAPHY 51776OtherCALIFORNIA STATE BOARD OF PHARMACY PERMIT
CAPHY 51776OtherCALIFORNIA STATE BOARD OF PHARMACY PERMIT