Provider Demographics
NPI:1235316068
Name:EL CAMINO PHARMACY, INC.
Entity Type:Organization
Organization Name:EL CAMINO PHARMACY, INC.
Other - Org Name:EL CAMINO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/ CEO/ CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-763-4334
Mailing Address - Street 1:10940 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3725
Mailing Address - Country:US
Mailing Address - Phone:818-763-4334
Mailing Address - Fax:818-763-4610
Practice Address - Street 1:10940 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3725
Practice Address - Country:US
Practice Address - Phone:818-763-4334
Practice Address - Fax:818-763-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 546283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1058020001Medicare NSC
CAPHA447830Medicaid