Provider Demographics
NPI:1689775306
Name:OLYMPIC GERHART PHARMACY INC
Entity Type:Organization
Organization Name:OLYMPIC GERHART PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-722-1515
Mailing Address - Street 1:5724 E OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5120
Mailing Address - Country:US
Mailing Address - Phone:323-722-1515
Mailing Address - Fax:323-722-2083
Practice Address - Street 1:5724 E OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5120
Practice Address - Country:US
Practice Address - Phone:323-722-1515
Practice Address - Fax:323-722-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY53845310400000X
CAPHY 538453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 53845OtherSTATE BOARD OF PHARMACY
CAPHA468320Medicaid
CA05-98625OtherNCPDP PROVIDER
CA5292610001Medicare NSC