Provider Demographics
NPI:1376514810
Name:CEDARS-SINAI MEDICAL CENTER PHARMACY #3
Entity Type:Organization
Organization Name:CEDARS-SINAI MEDICAL CENTER PHARMACY #3
Other - Org Name:SAN VICENTE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRIEDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-423-9550
Mailing Address - Street 1:444 S SAN VICENTE BLVD
Mailing Address - Street 2:#104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4165
Mailing Address - Country:US
Mailing Address - Phone:310-423-9550
Mailing Address - Fax:310-423-9551
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:#104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4165
Practice Address - Country:US
Practice Address - Phone:310-423-9550
Practice Address - Fax:310-423-9551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDAR-SINAI MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY34810333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA348100Medicaid
0596304OtherNABP #
CAPHY34810OtherSTATE PHARMACY LICENSE #
BC5109245OtherDEA NUMBER