Provider Demographics
NPI:1407065931
Name:TELEHEALTH PHARMACY ,INC
Entity Type:Organization
Organization Name:TELEHEALTH PHARMACY ,INC
Other - Org Name:TELEHEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JASIMINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-968-2422
Mailing Address - Street 1:17200 VENTURA BLVD
Mailing Address - Street 2:116
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4005
Mailing Address - Country:US
Mailing Address - Phone:877-797-9793
Mailing Address - Fax:818-904-1800
Practice Address - Street 1:17200 VENTURA BLVD
Practice Address - Street 2:116
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5029
Practice Address - Country:US
Practice Address - Phone:877-797-9793
Practice Address - Fax:818-904-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 53340333600000X
CA441841835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Single Specialty
Yes333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA441920Other3RD PARTY INSURANCE
CA441920Medicaid