Provider Demographics
NPI:1518272004
Name:CROWN CARE PHARMACY INC
Entity Type:Organization
Organization Name:CROWN CARE PHARMACY INC
Other - Org Name:ERX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSANI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-230-7661
Mailing Address - Street 1:2829 N SAN FERNANDO RD
Mailing Address - Street 2:#211
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1320
Mailing Address - Country:US
Mailing Address - Phone:818-230-7661
Mailing Address - Fax:888-600-1160
Practice Address - Street 1:2829 N SAN FERNANDO RD
Practice Address - Street 2:#211
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-1320
Practice Address - Country:US
Practice Address - Phone:818-230-7661
Practice Address - Fax:888-600-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 50365333600000X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 50365OtherRETAIL PHARMACY PERMIT