Provider Demographics
NPI:1518215086
Name:ENCINO FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:ENCINO FAMILY PHARMACY INC
Other - Org Name:ENCINO FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-387-8119
Mailing Address - Street 1:16060 VENTURA BLVD
Mailing Address - Street 2:UNIT #109
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2761
Mailing Address - Country:US
Mailing Address - Phone:818-387-8119
Mailing Address - Fax:818-387-8499
Practice Address - Street 1:16060 VENTURA BLVD
Practice Address - Street 2:UNIT #109
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2761
Practice Address - Country:US
Practice Address - Phone:818-387-8119
Practice Address - Fax:818-387-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy