Provider Demographics
NPI:1609327691
Name:CEDRA PHARMACY LOS ANGELES LLC
Entity Type:Organization
Organization Name:CEDRA PHARMACY LOS ANGELES LLC
Other - Org Name:CEDRA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARNABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-836-8886
Mailing Address - Street 1:724 ELTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-1244
Mailing Address - Country:US
Mailing Address - Phone:917-836-8886
Mailing Address - Fax:323-477-1272
Practice Address - Street 1:1417 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4123
Practice Address - Country:US
Practice Address - Phone:323-206-4466
Practice Address - Fax:323-477-1272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165719OtherPK