Provider Demographics
NPI:1467851352
Name:SANTA MONICA HOMEOPATHIC PHY
Entity Type:Organization
Organization Name:SANTA MONICA HOMEOPATHIC PHY
Other - Org Name:SANTA MONICA HOMEOPATHIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-395-1131
Mailing Address - Street 1:629 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2503
Mailing Address - Country:US
Mailing Address - Phone:310-395-1131
Mailing Address - Fax:310-395-7861
Practice Address - Street 1:629 BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2503
Practice Address - Country:US
Practice Address - Phone:310-395-1131
Practice Address - Fax:310-395-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY409463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004729OtherPK