Provider Demographics
NPI:1508362690
Name:HOSPICE PBM INC
Entity Type:Organization
Organization Name:HOSPICE PBM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:818-786-3110
Mailing Address - Street 1:16525 SHERMAN WAY STE C1
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3753
Mailing Address - Country:US
Mailing Address - Phone:818-786-3110
Mailing Address - Fax:818-786-3150
Practice Address - Street 1:3000 N HOLLYWOOD WAY FL 2
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1026
Practice Address - Country:US
Practice Address - Phone:818-786-3110
Practice Address - Fax:818-786-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service