Provider Demographics
NPI:1225146111
Name:COUNTY OF LOS ANGELES
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:OLIVE VIEW MEDICAL CENTER PHARMACY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NADRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALADY-BOUZIANA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:747-210-3059
Mailing Address - Street 1:14445 OLIVE VIEW DR
Mailing Address - Street 2:2A219
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1437
Mailing Address - Country:US
Mailing Address - Phone:747-210-3059
Mailing Address - Fax:747-210-3063
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:2A219
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:818-364-3065
Practice Address - Fax:818-364-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHE 32797Medicaid